Abstract
Purpose: This real-world study evaluated the effectiveness of different inhalation therapies in patients with symptomatic chronic obstructive pulmonary disease (COPD) in China and also explored the relevant factors that influence the effectiveness of inhalation therapy.Patients and Methods: We conducted a multicenter prospective longitudinal study that was carried out in 12 hospitals in China from December 2016 to June 2021. A face-to-face interview was conducted to collect data. Baseline data were collected at the first visit. Minimum clinically important difference (MCID) was defined as attaining a COPD assessment test (CAT) decrease ≥2. We mainly assessed the MCID and the incidence of exacerbations at the 6 months follow-up.Results: In 695 patients, the mean age was 62.5 ± 8.2 years, with a mean CAT score of 15.1 ± 6.0. Overall, 341 (49.1%) patients attained the MCID of CAT and the incidence of exacerbation during follow-up was 22.3%. Females were significantly more likely to attain MCID than male in COPD patients (adjusted odd ratio (aOR) = 1.93, adjusted 95% confidence interval (a95%CI) = 1.09–3.42, p = 0.024). Patients treated with LABA/LAMA or ICS/LABA/LAMA (ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist) were more likely to attain MCID than patients treated with LAMA (aOR = 3.97, a95%CI = 2.48–6.35, p < 0.001; aOR = 3.17, a95%CI = 2.09–4.80, p < 0.001, respectively). Patients treated with LABA/LAMA had a higher incidence of severe exacerbation than patients treated with ICS/LABA/LAMA (aOR = 1.95, a95%CI = 1.04–3.66, p = 0.038).Conclusion: The incidence of MCID in symptomatic COPD patients treated with inhalation therapy was nearly 50%. Patients treated with LABA/LAMA or ICS/LABA/LAMA were more likely to attain MCID than patients treated with LAMA. Patients treated with LABA/LAMA had a higher incidence of severe exacerbations than with ICS/LABA/LAMA.
Highlights
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with persistent airflow limitation caused by toxic particles or gases (Vogelmeier et al, 2017)
Our results show that the minimum clinically important difference (MCID) response rate (CAT improved ≥2) in symptomatic COPD patients treated with inhalation therapy was nearly 50% and the inhalation treatment of COPD patients with long-acting muscarinic antagonist (LAMA)/long-acting β2agonist (LABA) or triple therapy had a higher MCID response rate than LAMA or inhaled corticosteroids (ICS)/LABA
This study showed that combined LABA/LAMA inhalers appear to be as effective as combined ICS/LABA inhalers in preventing COPD exacerbations (Suissa et al, 2019), but an randomized controlled trials (RCTs) demonstrated that the time to the first severe exacerbation was longer in the LABA/LAMA group than in the ICS/LABA group (HR 0.81; 95% CI, 0.66 to 1.00; p 0.046) (Wedzicha et al, 2016)
Summary
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with persistent airflow limitation caused by toxic particles or gases (Vogelmeier et al, 2017). 174.5 million (2.4%) people suffer from COPD (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators, 2016), and the prevalence in patients over 40 years of age in China is 13.7% (Wang et al, 2018). COPD is one of the top three causes of death worldwide (Lozano et al, 2012). With the progression of COPD, the burden of symptoms increases and quality of life declines. Symptomatic patients with COPD (group B and D) account for the vast majority in China (Duan et al, 2020).
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