Comparison of Effectiveness Using Different Dual Bronchodilator Agents in Chronic Obstructive Pulmonary Disease Treatment

The effectiveness and safety of fixed dual long-acting bronchodilators for chronic obstructive pulmonary disease (COPD) patients have been well established; however, there is a paucity of clinical effectiveness comparison in patients with COPD treatment. The aim of the current study was to compare the effectiveness of three once-daily dual bronchodilator agents in patients with COPD. Patients with diagnosed COPD and treated with a long-acting beta-agonist (LABA) + long-acting muscarinic antagonist (LAMA) fixed-dose combination therapy (UME/VIL (umeclidinium and vilanterol inhalation powder), IND/GLY (indacaterol and glycopyrronium), and TIO/OLO (tiotropium and olodaterol)) were enrolled in this retrospective study over a period of 12 months. Effectiveness assessments were evaluated using a COPD assessment test (CAT) and lung function parameters. Besides, times for acute exacerbation were also assessed. The enrolled patients’ number was 177 in IND/GLY, 176 in UME/VIL and 183 in TIO/OLO. Lung function measurements with FEV1 had significantly improved for patients using TIO/OLO (98.7 mL) compared to those of IND/GLY (65.2 mL) and UME/VIL (64.4 mL) (p < 0.001). CAT scores were also significantly decreased in patients treated with TIO/OLO (CAT down 5.6) than those with IND/GLY (3.8) and UME/VIL (3.9) (p = 0.03). Acute exacerbation was also reduced in patients using TIO/OLO (4.9%) compared with those using IND/GLY (10.2%) and UME/VIL (11.9%) (p = 0.01). Significant improvement in pulmonary function, symptoms were demonstrated after 12 months of LABA/LAMA fixed-dose combination therapy with three different treatment options. TIO/OLO demonstrated higher therapeutic effects compared with UME/VIL or IND/GLY. Determining clinical relevance will require a well-designed randomized controlled trial.

Use of the inhaled corticosteroid to bronchodilator ratio in an audit of the treatment of asthma in an academic family medicine residency programme

INTRODUCTION: Asthma affects around 5% of the United States population, with 50% having uncontrolled symptoms. AIM: To improve asthma care by seeing if the inhaled corticosteroid to bronchodilator ratio (RATIO) is associated with asthma control and if non-clinical factors were associated with adherence to asthma guidelines. METHOD: A retrospective study using University of Oklahoma-Tulsa, School of Community Medicine Family Medicine Clinic electronic medical records of a random sample of 49 patients with asthma who were seen at least twice from July 2003 through June 2007 and did not have a diagnosis of chronic obstructive pulmonary disease or exercise-induced asthma. RESULTS: The RATIO for those prescribed corticosteroid inhalers was directly related to the actual step of asthma care (STEP) but inversely related to the number of prednisone courses prescribed per year (R2=.30, p=0.0012). The difference between the actual STEP and ideal STEP (had corticosteroid inhalers been prescribed for all the months in the study) was directly related to the percent of available salbutamol (albuterol) inhalers that non-clinicians refilled and inversely related to the actual STEP (R2=.45, p=1.8 x 10-5). The available corticosteroid inhalers prescribed was directly related to the actual STEP and inversely related to the number of comorbid diagnoses addressed at the last asthma visit (R2=.70, p=5.8 x 10-10). DISCUSSION: Efforts to both limit salbutamol medications, especially by non-clinicians, and simultaneously prescribe appropriate amounts of inhaled corticosteroids, through a dedicated asthma visit, should improve asthma control. A higher RATIO implies better asthma control. KEYWORDS: Asthma; anti-inflammatory agents; albuterol; bronchodilator agents; drug therapy, combination; medical audit