Different therapeutic responses in chronic obstructive pulmonary disease subgroups

Abstract

S E T T I N G : Eleven referring hospitals in South Korea. O B J E C T I V E :To compare therapeutic responses in chronic obstructive pulmonary disease (COPD) subgroups, classifi ed by diffusing capacity of the lung for carbon monoxide (DL CO ) and lung volume. D E S I G N : A total of 130 stable male COPD patients were classifi ed into four subgroups according to baseline DL CO and residual volume/total lung capacity (RV/TLC) ratio. We compared therapeutic responses to short acting β 2 -agonist (SABA) and 3-month combined inhalation of long-acting β 2 -agonist (LABA) and corticosteroid among patients with these subgroups. CHRONIC obstructive pulmonary disease (COPD) is characterised by chronic airfl ow limitation that is not fully reversible. 1 COPD is not a single disease but rather a group of conditions with variable clinical, physiological and radiographic manifestations. 2 S U M M A R YThe Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend different treatment strategies based on the severity of airfl ow limitation, as assessed by post-bronchodilator forced expiratory volume in 1 second (FEV 1 ) values. 1 Although FEV 1 is useful in the diagnosis and physiological staging of COPD, arbitrary stratifi cations of SDL and YMO contributed equally to this article.

Study Design and Outcomes of Korean Obstructive Lung Disease (KOLD) Cohort Study

“…The interim analyses of the KOLD Cohort Study identified various predictors of therapeutic response8,9,10,11. These include clinical, pulmonary functional, radiological or combined factors.…”

Efficacy and Safety of Roflumilast in Korean Patients with COPD

“… 26 In the Korean Obstructive Lung Disease (KOLD) cohort, chronic bronchitis was present in about 15% of COPD patients, 27 and the difference in clinical phenotype was found to possibly affect the response to pharmacological treatment. 28 29 30 31 Previous clinical trials in patients with severe or very severe COPD show that roflumilast reduces the frequency of exacerbations in a subset of COPD patients with chronic bronchitis. 11 Regrettably, our study did not have sufficient power to evaluate the effects of treatment on the frequency of exacerbations.…”

Three-month Treatment Response and Exacerbation in Chronic Obstructive Pulmonary Disease

“…Therefore, it is possible to apply therapeutic strategies that are similarly effective for all patients. According to recent reports, COPD patients were classified into their categories based on their response to the specific bronchodilators; however they could not find the relation between the categories and clinical outcome ( 4 , 12 , 13 , 15 ). For example, Albert et al ( 12 ) evaluated BDR as a potential COPD phenotype and indicator of therapeutic response, but found that BDR was not related to any particular clinical outcome.…”

“…Many recent studies support the effectiveness of bronchodilator and anti-inflammation therapy to improve lung function in specific subgroups of COPD patients ( 1 , 4 ). Several studies have found a significant relationship between the decline in lung function and poor clinical outcomes in COPD patients ( 5 , 6 , 7 , 8 , 9 ), but few have shown that improved lung function translates into improved clinical outcomes, including decreased exacerbation ( 10 , 11 ).…”