Abstract
Objective: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is of increasing interest because ACO patients have significantly worse outcomes, leading to greater social and economic burdens compared with asthma or COPD alone. Some guidelines for ACO recommend triple therapy with inhaled corticosteroids, long-acting β2 agonists, and long-acting muscarinic antagonists. However, this approach is based on extrapolating data from patients with asthma or COPD alone. Therapeutic studies for ACO have not previously been conducted. Materials and methods: A 12-week, randomized, open-label cross-over pilot study was conducted in 17 ACO patients to evaluate the effect of umeclidinium (UMEC) 62.5 µg once-daily added to fluticasone furoate/vilanterol (FF/VI) 200/25 µg once-daily. A 4-week run-in, a first and a second 4-week treatment period were included. Respiratory function, respiratory impedance, fractional exhaled nitric oxide, COPD assessment test, and asthma control test scores were evaluated 0, 4, and 8 weeks after randomization. Results: Mean values of post-bronchodilator forced expiratory volume in 1 second as a percentage of the predicted value (%FEV1), after UMEC was added to FF/VI, were significantly higher than after the run-in (p < 0.01). Mean values of resonant frequency during inspiration (Fres), after UMEC was added to FF/VI, were significantly lower than after the run-in (p < 0.01). Conclusion: Adding UMEC to FF/VI provides greater improvement in lung function, indicating that triple therapy is a suitable regular treatment for ACO.
Highlights
Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) has been the focus of attention [1, 2, 3] because patients with ACO have worse health-related quality of life, more rapid disease progression [4], more frequent respiratory exacerbation [5], increased comorbidities, and greater health care utilization, leading to a greater socioeconomic burden than for patients with asthma or COPD alone [6, 7, 8]
Materials and methods: A 12-week, randomized, open-label cross-over pilot study was conducted in 17 ACO patients to evaluate the effect of umeclidinium (UMEC) 62.5 μg once-daily added to fluticasone furoate/vilanterol (FF/VI) 200/25 μg once-daily
Most parameters were significantly higher after UMEC was added to the FF/VI treatment, compared with the corresponding values after the runin or the FF/VI treatment period
Summary
Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) has been the focus of attention [1, 2, 3] because patients with ACO have worse health-related quality of life, more rapid disease progression [4], more frequent respiratory exacerbation [5], increased comorbidities, and greater health care utilization, leading to a greater socioeconomic burden than for patients with asthma or COPD alone [6, 7, 8]. Triple therapy with inhaled corticosteroids (ICS), long-acting β2 agonists (LABA), and long-acting muscarinic antagonists (LAMA) has lately attracted considerable attention because it has been shown to be a useful and convenient treatment in patients with obstructive airway diseases [10, 11, 12]. Some guidelines recommend triple therapy with ICS, LABA, and LAMA to improve lung function and respiratory symptoms and to reduce respiratory exacerbations [3, 13, 14] This treatment approach is based on the extrapolation of data derived from studies of patients with asthma or COPD alone because therapeutic studies for ACO have not previously been conducted.
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