Abstract
Despite clinical benefits of long-acting muscarinic antagonist (LAMA)/long-acting beta2-agonist (LABA) double bronchodilator therapy, there has been limited evidence for treatment change from LAMA/LABA to inhaled corticosteroid (ICS)-containing therapy. This study aimed to assess the rate of ICS-containing therapy from LAMA/LABA and investigate the factors associated with ICS addition. Between October 2015 and March 2019, consecutive patients prescribed with a LAMA/LABA fixed-dose combinations (FDCs) therapy without ICS were retrospectively identified from a single-referral hospital. The primary outcome was addition of ICS. During LAMA/LABA FDCs therapy (median, 12.4 months), 47 (17.7%) out of 266 patients had ICS addition. Most patients maintained bronchodilators without addition of ICS at 12 (86.5%) or 24 (76.8%) months. Patients with dyspnea (mMRC ≥ 2) at baseline, previous ICS use, and exacerbation in the previous year were at a higher risk of ICS addition. Especially, exacerbation in the previous year and dyspnea were associated with the development of frequent exacerbations during LAMA/LABA FDCs therapy, which might have led to ICS addition. Double bronchodilator therapy could be well-maintained in stable COPD patients. However, patients with exacerbation in the previous year, dyspnea, and previous ICS use should be closely approached and monitored with initiation of LAMA/LABA FDCs therapy without ICS.
Highlights
Chronic obstructive pulmonary disease (COPD) is major global health burden contributing to 3.2 million deaths annually [1]
The aim of this study was to assess the rate of inhaled corticosteroid (ICS)-containing therapy from long-acting muscarinic antagonist (LAMA)/long-acting beta2-agonist (LABA) fixed-dose combinations (FDCs) and to investigate the factors associated with ICS addition in this new era of double bronchodilator therapy [21]
Among 266 COPD patients with double bronchodilator therapy of LAMA/LABA FDCs, we found that 87% of patients maintained bronchodilator therapy without adding ICS at 12 months and 77% of patients persisted with bronchodilator therapy without adding ICS at 24 months
Summary
Chronic obstructive pulmonary disease (COPD) is major global health burden contributing to 3.2 million deaths annually [1]. It is characterized by persistent airflow limitation that interferes with normal breathing and causes respiratory symptoms [2]. Real-world studies demonstrated the overuse of ICS even in COPD patients with mild to moderate disease [3,4,5]. A large United States claims database study revealed that most (75%) COPD patients receiving triple therapy had mild or moderate disease [5] and almost half of the COPD patients using ICS did not exhibit features indicative of ICS usage in 2017 from the nationwide multicenter cohorts in South Korea [7]. Among patients prescribed with triple therapy, 25% progressed to receive triple therapy within 1 year after the diagnosis and more than 50% did so within 3 years, irrespective of the COPD severity [4]
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