QVA149 Significantly Improves Lung Function and Reduces Rescue Medication Use Compared With Its Monocomponents in COPD Patients With Moderate-to-Severe Airflow Limitation: Pooled Analysis From the FLIGHT1 and FLIGHT2 Studies

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 729A ◽  
Author(s):  
Edward Kerwin ◽  
Tim Ayers ◽  
Donald Banerji ◽  
Samopriyo Maitra ◽  
Francesco Patalano
Keyword(s):  
Lung Function ◽  
Rescue Medication ◽  
Medication Use ◽  
Pooled Analysis ◽  
Airflow Limitation ◽  
Copd Patients

scholarly journals Efficacy of umeclidinium/vilanterol according to the degree of reversibility of airflow limitation at screening: a post hoc analysis of the EMAX trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Claus F. Vogelmeier ◽  
Paul W. Jones ◽  
Edward M. Kerwin ◽  
Isabelle H. Boucot ◽  
François Maltais ◽  
...  
Keyword(s):  
Lung Function ◽  
Rescue Medication ◽  
Inhaled Corticosteroids ◽  
Full Range ◽  
Medication Use ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Double Blind ◽  
Once Daily ◽  
Post Hoc

Abstract Background In patients with chronic obstructive pulmonary disease (COPD), the relationship between short-term bronchodilator reversibility and longer-term response to bronchodilators is unclear. Here, we investigated whether the efficacy of long-acting bronchodilators is associated with reversibility of airflow limitation in patients with COPD with a low exacerbation risk not receiving inhaled corticosteroids. Methods The double-blind, double-dummy EMAX trial randomised patients to umeclidinium/vilanterol 62.5/25 µg once daily, umeclidinium 62.5 µg once daily, or salmeterol 50 µg twice daily. Bronchodilator reversibility to salbutamol was measured once at screening and defined as an increase in forced expiratory volume in 1 s (FEV1) of ≥ 12% and ≥ 200 mL 10−30 min post salbutamol. Post hoc, fractional polynomial (FP) modelling was conducted using the degree of reversibility (mL) at screening as a continuous variable to investigate its relationship to mean change from baseline in trough FEV1 and self-administered computerised-Transition Dyspnoea Index (SAC-TDI) at Week 24, Evaluating Respiratory Symptoms-COPD (E-RS) at Weeks 21–24, and rescue medication use (puffs/day) over Weeks 1–24. Analyses were conducted across the full range of reversibility (−850–896 mL); however, results are presented for the range −100–400 mL because there were few participants with values outside this range. Results The mean (standard deviation) reversibility was 130 mL (156) and the median was 113 mL; 625/2425 (26%) patients were reversible. There was a trend towards greater improvements in trough FEV1, SAC-TDI, E-RS and rescue medication use with umeclidinium/vilanterol with higher reversibility. Improvements in trough FEV1 and reductions in rescue medication use were greater with umeclidinium/vilanterol compared with either monotherapy across the range of reversibility. Greater improvements in SAC-TDI and E-RS total scores were observed with umeclidinium/vilanterol versus monotherapy in the middle of the reversibility range. Conclusions FP analyses suggest that patients with higher levels of reversibility have greater improvements in lung function and symptoms in response to bronchodilators. Improvements in lung function and rescue medication use were greater with umeclidinium/vilanterol versus monotherapy across the full range of reversibility, suggesting that the dual bronchodilator umeclidinium/vilanterol may be an appropriate treatment for patients with symptomatic COPD, regardless of their level of reversibility.

scholarly journals Efficacy of indacaterol/glycopyrronium versus salmeterol/fluticasone in current and ex-smokers: a pooled analysis of IGNITE trials

2020 ◽  
pp. 00816-2020
Author(s):  
David M.G. Halpin ◽  
Claus F. Vogelmeier ◽  
Karen Mezzi ◽  
Pritam Gupta ◽  
Konstantinos Kostikas ◽  
...  
Keyword(s):  
Rescue Medication ◽  
Inhaled Corticosteroids ◽  
Smoking Status ◽  
Medication Use ◽  
Pooled Analysis ◽  
Forced Expiratory Volume ◽  
Limited Information ◽  
Asthmatic Patients ◽  
St George's Respiratory Questionnaire ◽  
The Difference

Inhaled corticosteroids have proven to be less effective in smoking asthmatic patients; however, there is limited information on the efficacy of inhaled corticosteroid-containing regimens in COPD patients who continue smoking. We evaluate the differential efficacy of once-daily indacaterol/glycopyrronium 110/50 µg compared with twice-daily salmeterol/fluticasone 50/500 µg in current smokers and ex-smokers, with COPD.A pooled analysis of data from ILLUMINATE, LANTERN and FLAME studies, was conducted to assess the efficacy of indacaterol/glycopyrronium compared with salmeterol/fluticasone in current smokers and ex-smokers, with COPD. Efficacy was assessed in terms of improvements in trough forced expiratory volume in 1 s (FEV1), transition dyspnoea index (TDI) focal score, St George's Respiratory Questionnaire (SGRQ) total score, reduced rescue medication use and exacerbation prevention at 26 weeks after the start of the therapy.In total, 1769 (38%) current smokers and 2848 (62%) ex-smokers were included. Patients treated with indacaterol/glycopyrronium experienced greater improvements in trough FEV1versus salmeterol/fluticasone in both current and ex-smokers (least squares mean treatment difference, 105 mL and 78 mL, respectively). Improvements in TDI focal score, SGRQ total score and reduction in rescue medication use were also greater with indacaterol/glycopyrronium versus salmeterol/fluticasone in current and ex-smokers. Further, indacaterol/glycopyrronium reduced all exacerbations (moderate/severe) compared with salmeterol/fluticasone, irrespective of smoking status. The difference in efficacy in favour of indacaterol/glycopyrronium was more prominent in current smokers in most cases.Indacaterol/glycopyrronium demonstrated greater efficacy versus salmeterol/fluticasone and the differences were generally more prominent in current smokers suggesting smoking may reduce the effects of salmeterol/fluticasone.

Twice-Daily Aclidinium Bromide In COPD Patients: Nighttime Symptoms And Rescue Medication Use In Accord COPD I

2011 ◽  
Author(s):  
Edward M. Kerwin ◽  
Stephen I. Rennard ◽  
Arthur F. Gelb ◽  
Ludmyla Rekeda ◽  
Esther Garcia Gil ◽  
...  
Keyword(s):  
Rescue Medication ◽  
Medication Use ◽  
Copd Patients ◽  
Aclidinium Bromide

scholarly journals Fibrocyte accumulation in bronchi: a cellular hallmark of COPD

2018 ◽  
Author(s):  
Isabelle Dupin ◽  
Matthieu Thumerel ◽  
Elise Maurat ◽  
Florence Coste ◽  
Hugues Begueret ◽  
...  
Keyword(s):  
Lung Function ◽  
Ct Scan ◽  
Wall Thickness ◽  
High Density ◽  
Airflow Limitation ◽  
Normal Lung ◽  
Chronic Obstructive ◽  
Lung Function Decline ◽  
Control Subjects ◽  
Copd Patients

AbstractBackgroundThe remodeling mechanism and cellular players causing persistent airflow limitation in chronic obstructive pulmonary disease (COPD) remain largely elusive. We have recently demonstrated that circulating fibrocytes, a rare population of fibroblast-like cells produced by the bone marrow stroma, are increased in COPD patients during an exacerbation. It remains, however, unclear, whether fibrocytes are present in bronchial tissue of COPD patients.ObjectiveWe aimed to quantify fibrocytes density in bronchial specimens from both control subjects and COPD patients, and to define associations with clinical, functional and computed tomography relevant parameters.Methods17 COPD patients and 25 control subjects with normal lung function testing and no chronic symptoms, all of them requiring thoracic surgery, were recruited. LFT and CT-scan were performed before surgery. Using co-immunostaining and image analysis, we identify CD45+ FSP1+ cells as tissue fibrocytes and quantify their density in distal and proximal bronchial specimens from the whole series.ResultsHere, we demonstrate that fibrocytes are increased in both distal and proximal tissue specimens of COPD patients, compared to those of controls. The density of fibrocytes is negatively correlated with lung function parameters, such as FEV1 and FEV1/FVC, and positively with bronchial wall thickness assessed by CT scan. High density of distal bronchial fibrocytes predicts presence of COPD with a sensitivity of 83% and a specificity of 70%.ConclusionsOur results thus suggest that recruitment of fibrocytes in the bronchi may participate to lung function decline during COPD progression.Clinical ImplicationsHigh density of tissue fibrocytes is associated with a deteriorated lung function and an increase in airway wall thickness. A low density tissue fibrocytes virtually eliminates the presence of COPD.Capsule summaryBlood fibrocytes assessed during exacerbation is a predictor of mortality in COPD. This study shows an increase of bronchial fibrocytes, that is associated with lower lung function, increased bronchial thickness and air trapping in COPD.

scholarly journals Seasonal variability of lung function and Asthma Quality of Life Questionnaire Scores in adults with uncontrolled asthma

2019 ◽  
Vol 6 (1) ◽  
pp. e000406
Author(s):  
Rebecca N Bauer ◽  
Xiaoying Yang ◽  
Tracy L Staton ◽  
Julie Olsson ◽  
Cecile T J Holweg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Function ◽  
Seasonal Variability ◽  
Rescue Medication ◽  
Medication Use ◽  
Life Questionnaire ◽  
Uncontrolled Asthma ◽  
Quality Of Life Questionnaire ◽  
Asthma Exacerbations

IntroductionAsthma exacerbations spike in the spring and autumn months, yet the seasonal variation of asthma symptoms and lung function is poorly studied.MethodsSeasonal variation of lung function, rescue medication use and patient-reported symptoms was evaluated by posthoc analyses of the Phase III lebrikizumab (anti-IL-13) LAVOLTA I and II studies in 2148 subjects with uncontrolled asthma. Lung function measurements (prebronchodilator FEV1, forced vital capacity (FVC) and peak expiratory flow (PEF)), rescue medication use and Standardised Asthma Quality of Life Questionnaire (AQLQ(S)) were measured every 4 weeks over 52 weeks. By-month estimates normalised by hemispheric season were based on mixed-effect models with repeated measures (MMRM), adjusted by study stratification factors as covariates when appropriate. The dependency of clinical outcomes with seasonal variability was assessed by employing linear contrasts comparing hemisphere normalised December versus July group means from an MMRM regression and presented as the difference in means (adjusted 95% CI).ResultsFEV1, FVC and PEF, rescue medication use and AQLQ(S) progressively worsened towards winter, unlike spring and autumn surges in asthma exacerbations. The December versus July mean differences were: (1) PEF=−6.5 (–8.7 to –4.2) L/min, 2) prebronchodilator FEV1=−42 (–57 to –27) mL, (3) FVC=−41 (−59 to –23) mL and (4) AQLQ(S)=−0.15 (–0.19 to –0.1) units. Among AQLQ questions, discomfort or distress related to cough was most variable with respect to season (−0.33 (−0.42 to –0.24) units).DiscussionInterpretation of interventional studies biased by seasonal exposures may be confounded by seasonal variability.Trials registration numbersNCT01867125 and NCT01868061.

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