Benefit of dual bronchodilator therapy on exacerbations in former and current smokers with chronic obstructive pulmonary disease in real-world clinical practice: a multicenter validation study (TOReTO).

Autor: Lai YT; Division of Pulmonary Medicine, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan., Tsai YH; Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan, Taiwan.; Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan.; Department of Pulmonary and Critical Care Medicine, Xiamen Chang Gung Hospital, Xiamen, People's Republic of China., Hsieh MJ; Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan, Taiwan.; Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan., Chen NH; Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan, Taiwan.; School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan., Cheng SL; Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan.; Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan, Taiwan., Tao CW; Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan., Wei YF; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.; Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan., Wu YK; Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, New Taipei, Taiwan., Chan MC; Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.; College of Medicine, National Chung Hsing University, Taichung, Taiwan., Liu SF; Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.; College of Medicine, Chang Gung University, Taoyuan, Taiwan., Hsu WH; Critical Medical Center, China Medical University Hospital, Taichung, Taiwan., Yang TM; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan., Liu CL; Division of Chest Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan., Kuo PH; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan., Lin MS; Division of Pulmonary Medicine, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan. 02456@cych.org.tw.
Jazyk: angličtina
Zdroj: Respiratory research [Respir Res] 2024 Oct 17; Vol. 25 (1), pp. 377. Date of Electronic Publication: 2024 Oct 17.
DOI: 10.1186/s12931-024-02971-3
Abstrakt: Background: Dual bronchodilator therapy, consisting of a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), has proven effective for patients with chronic obstructive pulmonary disease (COPD). However, it remains uncertain whether there are efficacy differences between current and former smokers with COPD. This study aims to explore the effectiveness of LABA/LAMA therapies in both these groups.
Methods: The TOReTO trial assessed lung function, symptoms, health status, the occurrence of exacerbations, clinically significant exacerbations, and the use of LABA/LAMA therapies. These therapies include Tio/Olo, umeclidinium/vilanterol (Umec/Vi), and umeclidinium/vilanterol (Umec/Vi) are used in patients with COPD. The study examined the differences in outcomes between current and former smokers. To balance the baseline characteristics, propensity score matching (PSM) was employed.
Results: Data from 967 patients were collected. After PSM, the time to the first acute exacerbation in current smokers was analyzed separately for the three treatment groups and was significantly different between them (p = 0.0457). Among, there are differences in the occurrence of acute exacerbation between treatment and smoking status in Umec/Vi (p = 0.0114). There is no significant difference in the treatment of former smokers among the three different groups of LABA/LAMA fixed-dose combinations (p = 0.3079). COPD-related symptoms remained stable throughout the treatment period. There were no significant differences in symptom scores, including CAT and mMRC, among the three groups at the end of the study.
Conclusions: The three fixed-dose combinations of LABA/LAMA showed no difference in reducing exacerbations in former smokers but did show differences in current smokers. This trend has clinical significance, and future research will be conducted to control influencing variables to validate this point. However, due to the non-randomized study design, these findings should be interpreted with caution.
(© 2024. The Author(s).)
Databáze: MEDLINE
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