{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:07:30Z","timestamp":1790140050524,"version":"4.0.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peak inspiratory flow rate (PIFR) is a critical determinant of inhaler-device compatibility, particularly when assessed under resistance conditions matching the prescribed inhaler. However, changes in device-matched PIFR patterns after inhaler coaching and factors associated with persistent abnormalities remain insufficiently characterized among hospitalized patients with chronic airway diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective single-center observational study of hospitalized adults with chronic obstructive pulmonary disease, asthma, or asthma\u2013COPD overlap who underwent routine device-matched PIFR assessment between July 2024 and December 2025. PIFR was measured using the In-Check DIAL G16 before and after standardized bedside coaching under resistance settings matched to the prescribed inhaler. Logistic regression analyses were performed to identify factors associated with persistent post-coaching PIFR abnormalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 286 patients, the distribution of device-matched PIFR shifted substantially toward the device-specific optimal PIFR range after bedside assessment and coaching. The proportion of patients within the optimal PIFR range increased from 42.3% to 89.2%, whereas insufficient and excessive PIFR decreased from 25.2% to 6.9% and from 32.5% to 3.9%, respectively (all P &amp;lt; 0.001). Lower body mass index was independently associated with persistent insufficient PIFR, whereas ICS-containing therapy was also associated with this residual abnormality. Persistent excessive PIFR was uncommon and primarily observed among patients using pMDI\/SMI devices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Device-matched PIFR assessment combined with individualized coaching was associated with a substantial shift toward the device-specific optimal PIFR range among hospitalized patients with chronic airway diseases. However, persistent insufficient PIFR remained in a subset of patients and was associated with lower BMI and ICS-containing therapy, suggesting that these factors may help identify patients who warrant closer reassessment of inhaler\u2013device compatibility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1903204","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:50:39Z","timestamp":1790139039000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in device-matched peak inspiratory flow after bedside inhaler coaching and factors associated with residual suboptimal flow: a retrospective observational study"],"prefix":"10.3389","volume":"17","author":[{"given":"Yuhang","family":"Ding","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Nanjing Drum Tower Hospital, China Pharmaceutical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengnan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanjing Drum Tower Hospital, China Pharmaceutical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhong","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanjing Drum Tower Hospital, China Pharmaceutical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinping","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuhui","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1124\/pharmrev.120.000108","article-title":"Inhaled medicines: past, present, and future","volume":"74","author":"Anderson","year":"2022","journal-title":"Pharmacol. 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