Effect of pulmonary rehabilitation with assistive use of short-acting β2 agonist in COPD patients using long-acting bronchodilators

Abstract Background In chronic obstructive pulmonary disease (COPD) patients, combination treatment with long-acting muscarinic antagonist (LAMA) and long-acting β2 agonist (LABA) increases forced expiratory volume in one second and reduces symptoms compared to monotherapy. In Japan, three different once-daily fixed-dose combinations (FDCs) have been prescribed since 2015, although a direct comparison of these FDCs has never been performed. The objective of the present study was to compare the effectiveness, preference, and safety of three LAMA/LABA FDCs—glycopyrronium/indacaterol (Gly/Ind), umeclidinium/vilanterol (Ume/Vil), and tiotropium/olodaterol (Tio/Olo)—in patients with COPD. Methods We enrolled 75 COPD outpatients (male:female ratio, 69:6; 77.4 ± 6.9 years). A prospective, randomized, crossover study was conducted on three groups using three FDCs: Gly/Ind; Ume/Vil; and Tio/Olo. Each medication was administered for 4 weeks before crossover (total 12 weeks). After each FDC administration, a respiratory function test and questionnaire survey were conducted. A comparative questionnaire survey of all three LAMA/LABA FDCs was conducted after 12 weeks (following administration of final FDC). Results No significant differences in COPD Assessment Test or modified Medical Research Council dyspnea questionnaire were reported in the surveys completed after each FDC administration; no significant differences in spirometric items were observed. In the final comparative questionnaire survey, patients reported better actual feeling of being able to inhale following Gly/Ind administration compared with Tio/Olo, although no significant differences in adverse events or other evaluations were reported. Conclusions The three LAMA/LABA FDCs administered to COPD patients show similar effects and safety, although some minor individual preference was reported. Trial registration This study retrospectively registered with the University Hospital Medical Information Network Clinical Trials Registry (number UMIN000041342, registered on August 6, 2020).

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Risk of all-cause hospitalization in COPD patients initiating long-acting or short-acting beta agonist therapy

Journal of Medical Economics ◽

10.3111/13696998.2013.815625 ◽

2013 ◽

Vol 16 (8) ◽

pp. 1082-1088 ◽

Cited By ~ 2

Author(s):

Vamsi Bollu ◽

Flavia Ejzykowicz ◽

Krithika Rajagopalan ◽

John Karafilidis ◽

Joel W. Hay

Keyword(s):

Beta Agonist ◽

Agonist Therapy ◽

Short Acting ◽

Copd Patients ◽

Long Acting

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Efficacy of an inhaled corticosteroid/long-acting β2-agonist combination in symptomatic COPD patients in GOLD groups B and D

European Respiratory Journal ◽

10.1183/09031936.00047115 ◽

2015 ◽

Vol 46 (1) ◽

pp. 255-258

Author(s):

Antonio Anzueto ◽

Christine R. Jenkins ◽

Barry J. Make ◽

Magnus Lindberg ◽

Peter M. Calverley ◽

...

Keyword(s):

Inhaled Corticosteroid ◽

Copd Patients ◽

Long Acting ◽

Β2 Agonist

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Short-acting β2-agonist and oral corticosteroid use in asthma patients prescribed either concurrent beclomethasone and long-acting β2-agonist or salmeterol/fluticasone propionate combination

International Journal of Clinical Practice ◽

10.1111/j.1742-1241.2005.00455.x ◽

2005 ◽

Vol 59 (2) ◽

pp. 156-162 ◽

Cited By ~ 14

Author(s):

R. Angus ◽

R. Reagon ◽

A. Cheesbrough

Keyword(s):

Fluticasone Propionate ◽

Oral Corticosteroid ◽

Short Acting ◽

Asthma Patients ◽

Long Acting ◽

Β2 Agonist

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COPD patients prescribed inhaled corticosteroid in general practice: Based on disease characteristics according to guidelines?

Chronic Respiratory Disease ◽

10.1177/1479973119867949 ◽

2019 ◽

Vol 16 ◽

pp. 147997311986794 ◽

Cited By ~ 2

Author(s):

Osman Savran ◽

Nina Godtfredsen ◽

Torben Sørensen ◽

Christian Jensen ◽

Charlotte Suppli Ulrik

Keyword(s):

Primary Care ◽

General Practice ◽

Symptom Severity ◽

Airflow Limitation ◽

Disease Characteristics ◽

Copd Patients ◽

Co Morbidity ◽

Long Acting ◽

Blood Eosinophils ◽

Β2 Agonist

In a primary care setting, our aim was to investigate characteristics of patients classified as having chronic obstructive pulmonary disease (COPD) and currently being prescribed inhaled corticosteroids (ICSs). The electronic patient record system in each participating general practice was searched for patients coded as COPD (ICPC, Second Edition code R95) and treated with ICS (ACT code R03AK and R03BA, that is, ICS in combination with a long-acting β2-agonist) or ICS as monotherapy. Data, if available, on demographics, smoking habits, spirometry, COPD medication, symptom score, blood eosinophils, co-morbidity and exacerbation history were retrieved from the medical records for all identified cases. Of all patients registered in the 138 participating general practices, 12.560 (3%) were coded as COPD, of whom 32% were prescribed ICS. The final study sample comprised 2.289 COPD patients currently prescribed ICS (98% also prescribed long-acting β2-agonist), with 24% being coded as both COPD and asthma. Post-bronchodilator spirometry was available in 79% (mean forced expiratory volume in 1 second 60% pred (standard deviation (SD) 23.3)), symptom severity score in 53% (mean Medical Research Council score 2.7 (SD 1.1)) and 56% of the COPD patients had had no exacerbation in the previous year (and 45% not within the 2 previous years). Blood eosinophils were measured in 67% of the patients. Information on severity of airflow limitation was missing in 15% of the patients, and the combined information on symptom severity and exacerbation history was missing in in 46%. Most of the patients (74%) were managed only by their general practitioner. Although only one-third of the COPD patients were prescribed ICSs, our findings from this study of a large cohort of patients prescribed ICSs for COPD in general practice suggest that more detailed assessment of diagnosis and disease characteristics is likely to improve the risk–benefit ratio of maintenance therapy with ICSs in COPD patients managed in primary care.

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