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Article ; Online: Utility of peak inspiratory flow measurement for dry powder inhaler use in chronic obstructive pulmonary disease.

Loh, Chee Hong / Ohar, Jill A

2023 Volume 30, Issue 2, Page(s) 174–178

Abstract: Purpose of review: Every type of dry powder inhaler (DPI) device has its own intrinsic resistance. A patient's inspiratory effort produces a pressure drop that determines the inspiratory flow, depending on the inhaler's specific internal resistance. ... ...

Abstract	Purpose of review: Every type of dry powder inhaler (DPI) device has its own intrinsic resistance. A patient's inspiratory effort produces a pressure drop that determines the inspiratory flow, depending on the inhaler's specific internal resistance. Optimal peak inspiratory flow (PIF) is needed for effective release of dry powder, disaggregation of drug-carrier agglomerates, and optimal deposition of respirable drug particles, particularly generation of a high fine-particle fraction to reach the small airways of the lungs. However, standardized recommendations for PIF measurements are lacking and instructions appeared vague in many instances. Recent findings: Suboptimal PIFs are common in outpatient chronic obstructive pulmonary disease (COPD) patients and during acute exacerbations of COPD, and are associated with increased healthcare resource utilization. There is significant variation in the results of studies which is in part related to different definitions of optimal flow rates, and considerable variation in how PIF is measured in clinical and real-life studies. Summary: Standardization of technique will facilitate comparisons among studies. Specific recommendations for PIF measurement have been proposed to standardize the process and better ensure accurate and reliable PIF values in clinical trials and clinical practice. Clinicians can then select and personalize the most appropriate inhaler for their patients and help them achieve the optimal PIF needed for effective drug dispersion.
MeSH term(s)	Humans ; Dry Powder Inhalers ; Pulmonary Disease, Chronic Obstructive ; Lung ; Administration, Inhalation
Language	English
Publishing date	2023-12-26
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1285505-4
ISSN	1531-6971 ; 1070-5287 ; 1078-1641
ISSN (online)	1531-6971
ISSN	1070-5287 ; 1078-1641
DOI	10.1097/MCP.0000000000001043
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Article ; Online: Aerosol Plumes of Inhalers Used in COPD.

Wachtel, Herbert / Emerson-Stadler, Rachel / Langguth, Peter / Hohlfeld, Jens M / Ohar, Jill

Pulmonary therapy

2024 Volume 10, Issue 1, Page(s) 109–122

Abstract: Introduction: The selection of inhaler device is of critical importance in chronic obstructive pulmonary disease (COPD) as the interaction between a patient's inhalation profile and the aerosol characteristics of an inhaler can affect drug delivery and ... ...

Abstract	Introduction: The selection of inhaler device is of critical importance in chronic obstructive pulmonary disease (COPD) as the interaction between a patient's inhalation profile and the aerosol characteristics of an inhaler can affect drug delivery and lung deposition. This study assessed the in vitro aerosol characteristics of inhaler devices approved for the treatment of COPD, including a soft mist inhaler (SMI), pressurized metered-dose inhalers (pMDIs), and dry powder inhalers (DPIs). Methods: High-speed video recording was used to visualize and measure aerosol velocity and spray duration for nine different inhalers (one SMI, three pMDIs, and five DPIs), each containing dual or triple fixed-dose combinations of long-acting muscarinic receptor antagonists and long-acting β Results: The Respimat SMI had the slowest plume velocity (0.99 m/s) and longest spray duration (1447 ms) compared with pMDIs (velocity: 3.65-5.09 m/s; duration: 227-270 ms) and DPIs (velocity: 1.43-4.60 m/s; duration: 60-757 ms). With increasing flow rates, SMI aerosol duration was unaffected, but velocity increased (maximum 2.63 m/s), pMDI aerosol velocity and duration were unaffected, and DPI aerosol velocity tended to increase, with a more variable impact on duration. Conclusions: Aerosol characteristics (velocity and duration of aerosol plume) vary by inhaler type. Plume velocity was lower and spray duration longer for the SMI compared with pMDIs and DPIs. Increasing experimental flow rate was associated with faster plume velocity for DPIs and the SMI, with no or variable impact on plume duration, whereas pMDI aerosol velocity and duration were unaffected by increasing flow rate.
Language	English
Publishing date	2024-01-09
Publishing country	United States
Document type	Journal Article
ISSN	2364-1746
ISSN (online)	2364-1746
DOI	10.1007/s41030-023-00249-5
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Article ; Online: Medicare Bundled Payments for Care Improvement Initiative for Chronic Obstructive Pulmonary Disease Readmissions: A Negative Study That Has Positive Implications.

Ohar, Jill A

Annals of the American Thoracic Society

2017 Volume 14, Issue 5, Page(s) 617–618

MeSH term(s)	Health Expenditures ; Humans ; Medicare ; Patient Readmission ; Pulmonary Disease, Chronic Obstructive ; United States
Language	English
Publishing date	2017-05-01
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.201701-011ED
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Zs.A 5828: Show issues

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Article ; Online: Clinical Burden of Chronic Obstructive Pulmonary Disease in Patients with Suboptimal Peak Inspiratory Flow.

Ohar, Jill A / Mahler, Donald A / Davis, Gabrielle N / Lombardi, David A / Moran, Edmund J / Crater, Glenn D

Canadian respiratory journal

2024 Volume 2024, Page(s) 8034923

Abstract: Introduction: Many patients with chronic obstructive pulmonary disease (COPD) may derive inadequate benefit from dry powder inhalers (DPIs) because of suboptimal peak inspiratory flow (sPIF).: Objectives: To assess the clinical burden of COPD by ... ...

Abstract	Introduction: Many patients with chronic obstructive pulmonary disease (COPD) may derive inadequate benefit from dry powder inhalers (DPIs) because of suboptimal peak inspiratory flow (sPIF). Objectives: To assess the clinical burden of COPD by characterizing the clinical characteristics of participants with sPIF against medium-low resistance DPIs versus those with optimal PIF (oPIF) from two phase 3 clinical trials. Methods: Baseline data were collected from two randomized, controlled, phase 3 trials (NCT03095456; NCT02518139) in participants with moderate-to-severe COPD. oPIF (60 L/min) against the medium-low resistance DPIs was used as the threshold for defining the PIF subgroups (<60 L/min (sPIF) vs ≥60 L/min (oPIF)). Results: Most participants included in this analysis were White (92%) and male (63%); the mean (range) age was 65 (43-87) years. Participants with sPIF had significantly greater dyspnea than those with oPIF as measured using the modified Medical Research Council scoring (mean (95% CI): 2.1 (2.0-2.2) vs 1.6 (1.4-1.7); Conclusion: In these trials, participants with COPD who had sPIF against the medium-low resistance DPIs had more dyspnea and worse health status than those with oPIF. These results demonstrate that sPIF is associated with a higher clinical burden as measured by patient-reported outcomes.
MeSH term(s)	Aged ; Aged, 80 and over ; Humans ; Male ; Administration, Inhalation ; Dry Powder Inhalers ; Dyspnea/etiology ; Pulmonary Disease, Chronic Obstructive ; Symptom Burden ; Female ; Adult ; Middle Aged ; Clinical Trials, Phase III as Topic ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2024-03-22
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	1213103-9
ISSN	1916-7245 ; 1198-2241
ISSN (online)	1916-7245
ISSN	1198-2241
DOI	10.1155/2024/8034923
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Article ; Online: Risks May Not Be Reasons for COPD Readmissions.

Ohar, Jill A

Annals of the American Thoracic Society

2015 Volume 12, Issue 9, Page(s) 1259–1260

MeSH term(s)	Humans ; Length of Stay/economics ; Medicare/economics ; Patient Discharge/economics ; Patient Readmission/economics ; Pulmonary Disease, Chronic Obstructive/economics
Language	English
Publishing date	2015-09
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.201507-444ED
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Article: Personalization of Device Therapy - Prime Time for Peak Inspiratory Flow Rate.

Loh, Chee H / Ohar, Jill A

Chronic obstructive pulmonary diseases (Miami, Fla.)

2017 Volume 4, Issue 3, Page(s) 172–176

Language	English
Publishing date	2017-07-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2771715-X
ISSN	2372-952X
ISSN	2372-952X
DOI	10.15326/jcopdf.4.3.2017.0155
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Article: Will Remotely Based Pulmonary Rehabilitation Water Down Its Effectiveness?

Rawal, Himanshu / Cornelison, Sharon D / Flynn, Sheryl M / Ohar, Jill A

Life (Basel, Switzerland)

2021 Volume 11, Issue 11

Abstract: Despite numerous benefits, traditional Pulmonary Rehabilitation (PR) as a resource remains underutilized in chronic lung disease. Less than 3% of eligible candidates for PR attend one or more sessions after hospitalization due to many barriers, including ...

Abstract	Despite numerous benefits, traditional Pulmonary Rehabilitation (PR) as a resource remains underutilized in chronic lung disease. Less than 3% of eligible candidates for PR attend one or more sessions after hospitalization due to many barriers, including the ongoing COVID-19 pandemic. Emerging alternative models of PR delivery such as home-based PR, tele-rehabilitation, web-based PR, or hybrid models could help address these barriers. Numerous studies have tested the feasibility, safety, and efficacy of these methods, but there is wide variability across studies and methods. We conducted a literature review to help determine if these alternative delivery methods watered down the effectiveness of PR. To evaluate the effectiveness of remotely based PR, the authors performed a literature search for randomized controlled trials (RCTs), cohort studies, and case series using PubMed, CINAHL, and Medline to identify relevant articles through 1 May 2021. Twenty-six applicable studies were found in which 11 compared tele-rehabilitation to conventional clinic-based PR; 11 evaluated tele-rehabilitation using the patient's baseline status as control; and four compared tele-rehabilitation to no rehabilitation. Despite the different technologies used across studies, tele-rehabilitation was found to be both a feasible and an efficacious option for select patients with lung disease. Outcomes across these studies demonstrated similar benefits to traditional PR programs. Thus the existing data does not show that remotely based PR waters down the effectiveness of conventional PR. Use of remotely based PR is a feasible and effective option to deliver PR, especially for patients with significant barriers to conventional clinic-based PR. Additional, well-conducted RCTs are needed to answer the questions regarding its efficacy, safety, cost-effectiveness and who, among patients with COPD and other lung diseases, will derive the maximum benefit.
Language	English
Publishing date	2021-11-20
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life11111270
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Article ; Online: Improvements in health status with revefenacin, a once-daily, nebulized, long-acting muscarinic antagonist for chronic obstructive pulmonary disease.

Donohue, James F / Ferguson, Gary T / Ohar, Jill A / Lombardi, David A / Schneider, Roslyn F / Johnson, Karmon

Respiratory medicine

2023 Volume 208, Page(s) 107123

Abstract: Background: Replicate, 12-week, phase 3 trials (0126 and 0127) of once-daily nebulized revefenacin 175 μg vs placebo demonstrated significant bronchodilation and improvements in health status in patients with moderate to very severe chronic obstructive ... ...

Abstract	Background: Replicate, 12-week, phase 3 trials (0126 and 0127) of once-daily nebulized revefenacin 175 μg vs placebo demonstrated significant bronchodilation and improvements in health status in patients with moderate to very severe chronic obstructive pulmonary disease (COPD). This post hoc analysis evaluated improvement in patient-reported outcomes (PROs), including the St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and Clinical COPD Questionnaire (CCQ) in both women and men. Methods: Participants were pooled from the two 12-week studies (411 [51%] women and 401 [49%] men). Changes in PROs were assessed overall and separately in men and women. Results: Revefenacin improved SGRQ and CAT total scores from baseline in both studies; improvement in CCQ total score reached significance only in 0126. In pooled data, a greater proportion of patients achieved clinically meaningful response in SGRQ score (≥4-unit decrease from baseline) with revefenacin vs placebo (odds ratio, 1.5; 95% confidence interval, 1.1-2.1; P = 0.012). Clinically meaningful responses were also seen in CAT (≥2-unit decrease from baseline) and CCQ (≥0.4-unit decrease from baseline) scores with revefenacin vs placebo. When stratified by sex, improvements from baseline in SGRQ, CAT, and CCQ scores following revefenacin vs placebo reached statistical significance only in women. Conclusions: Maintenance treatment with revefenacin improved health status in patients with moderate to very severe COPD; however, the effect was more pronounced for women than men. Clinicaltrials: GOV: NCT02459080; NCT02512510.
MeSH term(s)	Female ; Humans ; Male ; Benzamides ; Bronchodilator Agents/therapeutic use ; Forced Expiratory Volume ; Health Status ; Muscarinic Antagonists ; Pulmonary Disease, Chronic Obstructive
Chemical Substances	Benzamides ; Bronchodilator Agents ; Muscarinic Antagonists ; revefenacin (G2AE2VE07O)
Language	English
Publishing date	2023-01-18
Publishing country	England
Document type	Clinical Trial, Phase III ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1003348-8
ISSN	1532-3064 ; 0954-6111
ISSN (online)	1532-3064
ISSN	0954-6111
DOI	10.1016/j.rmed.2023.107123
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Article ; Online: Pharmacotherapy for Chronic Obstructive Pulmonary Disease: Molecules and Delivery Are Equally Important.

Mahler, Donald A / Ohar, Jill A / Ferguson, Gary T / Donohue, James F

American journal of respiratory and critical care medicine

2020 Volume 202, Issue 10, Page(s) 1482

MeSH term(s)	Bronchodilator Agents/therapeutic use ; Humans ; Pulmonary Disease, Chronic Obstructive/drug therapy ; United States
Chemical Substances	Bronchodilator Agents
Language	English
Publishing date	2020-09-17
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.202004-1489LE
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Article ; Online: Asthma-Chronic Obstructive Pulmonary Disease Overlap: Diagnostic and Management Challenges.

Ohar, Jill / Putcha, Nirupama / Bradshaw, Molly

The Journal of family practice

2019 Volume 67, Issue 10 Suppl, Page(s) S46–S51

MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Adrenergic beta-Agonists/therapeutic use ; Asthma/complications ; Asthma/diagnosis ; Asthma/therapy ; Disease Management ; Drug Therapy, Combination ; Health Education/standards ; Humans ; Patient Education as Topic/standards ; Practice Guidelines as Topic ; Precision Medicine ; Pulmonary Disease, Chronic Obstructive/complications ; Pulmonary Disease, Chronic Obstructive/diagnosis ; Pulmonary Disease, Chronic Obstructive/therapy ; Quality of Health Care ; Severity of Illness Index ; United States
Chemical Substances	Adrenal Cortex Hormones ; Adrenergic beta-Agonists
Language	English
Publishing date	2019-01-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	197883-4
ISSN	1533-7294 ; 0094-3509
ISSN (online)	1533-7294
ISSN	0094-3509
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