Predictors of short-term LAMA ineffectiveness in treatment naïve patients with moderate to severe COPD.

Autor: Fijačko V; Department of Pulmonology, University Hospital Center Osijek, Osijek, Croatia.; Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia., Labor M; Department of Pulmonology, University Hospital Center Osijek, Osijek, Croatia.; Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia., Fijačko M; Department of Clinical Laboratory Diagnostics, University Hospital Center Osijek, Osijek, Croatia., Škrinjarić-Cincar S; Department of Pulmonology, University Hospital Center Osijek, Osijek, Croatia.; Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia., Labor S; Department of Pulmonology, University Hospital Center Osijek, Osijek, Croatia.; Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia., Dumbović Dubravčić I; Department of Allergy and Pulmonology, Children's Hospital Srebrnjak, Zagreb, Croatia., Bačun T; Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia.; Department of Medicine, University Hospital Center Osijek, Osijek, Croatia., Včev A; Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia.; Department of Medicine, University Hospital Center Osijek, Osijek, Croatia., Popović-Grle S; Department of Allergology, Clinical Center for Pulmonary Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia.; School of Medicine, University of Zagreb, Zagreb, Croatia., Plavec D; Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia. plavec@bolnica-srebrnjak.hr.; Research Department, Children's Hospital Srebrnjak, Srebrnjak 100, Zagreb, Croatia. plavec@bolnica-srebrnjak.hr.
Jazyk: angličtina
Zdroj: Wiener klinische Wochenschrift [Wien Klin Wochenschr] 2018 Apr; Vol. 130 (7-8), pp. 247-258. Date of Electronic Publication: 2018 Jan 10.
DOI: 10.1007/s00508-017-1307-7
Abstrakt: Background: No specific (only subgroup) recommendations for the use of long-acting muscarinic antagonists in chronic obstructive pulmonary disease (COPD) exist. The aim of this exploratory hypothesis generating study was to assess whether different phenotypic/endotypic characteristics could be determinants of the short-term ineffectiveness of the initial tiotropium bromide monotherapy in treatment naïve moderate to severe COPD patients.
Methods: A total of 51 consecutively recruited COPD patients were followed for 3 months after the initial evaluation and prescribed initial treatment (tiotropium). Short-term treatment ineffectiveness was assessed as a composite measure comprising COPD exacerbations, need for additional treatment, and no improvement in functional parameters, e.g. 6‑min walking test (6MWT), body-mass index, airflow obstruction, dyspnea, and exercise (BODE) index and forced expiratory volume in 1 s (FEV 1 ), and as single components.
Results: Treatment ineffectiveness was significantly associated with baseline hemoglobin level, COPD assessment test (CAT) score, modified Medical Research Council (mMRC) scale and BODE index (p = 0.002). Incident exacerbation during the follow-up was associated with baseline bronchoalveolar lavage fluid (BALF) alpha-amylase level and CAT score (p < 0.001), and change in treatment with leukocyte count, 6MWT desaturation and fatigue (p < 0.001). No improvement in 6MWT was associated with baseline CAT score, body mass index, mMRC, fatigue, 6MWT and BODE index (p = 0.002). No improvement in BODE index was associated with leukocyte count, serum interleukin 8 (IL-8) and BALF albumin levels (p < 0.001); and no improvement in FEV 1 with CAT score, baseline vital capacity and BALF tumor necrosis factor alpha (TNF-alpha) level (p < 0.001).
Conclusion: Our results suggest that there is a possibility to identify predictors of short-term tiotropium ineffectiveness in patients with moderate to severe COPD.
Databáze: MEDLINE
Externí odkaz: