P288 Copd patients with varying severity of airflow limitation achieve highest peak inspiratory flow rate via the breezhaler® inhaler compared to the ellipta® or the handihaler® dry powder inhalers

Background and aim Chronic and progressive nature of COPD necessitates the patients to regularly self-administer inhaledmedication. Inhalationeffort required and flow rates achieved through DPIs, are some of the important considerations while selecting dry power inhalers(DPIs). Here, we present the comparison of the peak inspiratory flow (PIF) rates achieved by COPD patients, with varying degrees of airflowlimitation, through three types of DPIs (Breezhaler®, Ellipta® and HandiHaler®). We also assessed the effect of severity of airflowlimitation on PIF rates. Methods This randomised, open-label, multicentre and cross-over study recruited patients with moderate-to-very severe airflowlimitation (GOLD 2014) aged ≥40 years with a smoking history of ≥10 pack years. No active drug or placebo was administered during the study. After training the patients on correct use, inhalationflow profiles of patients were recorded using pressure tapped inhalersattached to a pressure transducer. For each patient, the inhalationprofile with the highest PIF rate, out of three replicate inhalationsper device, was selected for analysis. The primary analysis was based on the per-protocol set comprising 93 patients who completed all three inhalationsper device. A paired t-test was performed to compare PIF means between each combination of devices. Results In total, 97 COPD patients were randomised, of whom 96 completed the study and 93 patients (per-protocol set) were included in the analysis. The highest mean PIF rate (L/min ± SE) was observed with the Breezhaler® (107.5 ± 2.4), followed by the Ellipta® (80.0 ± 2.2) and the HandiHaler® (53.6 ± 2.1), in all patients (patients with moderate-to-very severe airflowlimitation). The mean PIF rate (L/min) achieved via the Breezhaler® was higher vs the Ellipta® (mean difference[Δ] = 27.7; p Conclusions COPD patients with varying degree of airflowlimitation (moderate-to-very severe COPD) achieved the highest PIF rates via the Breezhaler® compared with the Ellipta® or the HandiHaler® inhaler.