The following is a summary of “Therapeutic Response to Single-Inhaler Triple Therapies in Moderate-to-Severe COPD,” published in the March 2023 issue of Respiratory Care by Ohtsuka et al.
Chronic obstructive pulmonary disease (COPD) is distinguished by gradual and permanent constriction of the airways. Incorporating an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting β2-agonist into a single-inhaler therapy (SITT) has demonstrated significant efficacy in alleviating symptoms and enhancing lung function. In Japan, SITT formulations of Fluticasone-furoate/umeclidinium/vilanterol (F/U/V) and budesonide/glycopyrronium/formoterol (B/G/F) are currently accessible. However, the clinical distinctions between these two combinations and the factors determining their appropriate usage have yet to be determined.
The objective of this study was to ascertain the subject characteristics that could serve as predictors of the efficacy of inhaler therapy. The pulmonary function test results of individuals diagnosed with COPD were evaluated before and one month after utilizing F/U/V and B/G/F as SITT. Individuals exhibiting a 100 mL or greater disparity in the Forced Expiratory Volume in one second (FEV1) after pre-SITT treatment were selected for analysis. These individuals were then separated into two groups: those who experienced a positive outcome (F/U/V effect and B/G/F effect groups) and those who did not (no-effect groups). The aim was to investigate the variables linked to favorable results with each inhaler.
The follow-up visit and the administration of bronchodilators, glucocorticoids, and a combination of bronchodilators and glucocorticoids resulted in a noteworthy enhancement of the inspiratory capacity (IC), percentage of inspiratory capacity (%IC), forced vital capacity (FVC), and percentage of forced expiratory volume in one second (%FEV1) in comparison to the values before the intervention (P < .001, P = .001, P = .007, P = .009, respectively, for follow-up visit/bronchodilators/glucocorticoids; and P = .006, P = .008, P = .038, P = .005, respectively, for bronchodilators/glucocorticoids/combination therapy).
The study found that a lower %IC (odds ratio 0.97 [95% CI 0.94–0.99], P = .03) and a higher modified Medical Research Council (mMRC) dyspnea score (2.36 [1.27–4.70], P < .01) were correlated with an improvement in FEV1 in patients who underwent follow-up visits. Furthermore, an elevated %IC (1.03 [1.00–1.06], P = .02) and reduced mMRC dyspnea score (0.55 [0.28–0.99], P = .041) were identified as prognostic factors for the efficacy of B/G/F. The findings indicate that SITT intervention significantly improved IC, %IC, FVC, and %FEV1 compared to the pre-intervention phase. Moreover, it was observed that F/U/V was more efficacious in individuals with severe symptoms, while B/G/F was found to be more effective in those with mild symptoms.
Source: rc.rcjournal.com/content/68/3/330
