Disease severity and symptoms among patients receiving monotherapy for COPD

Abstract

Aim: To examine the burden of respiratory symptoms, quality of life and co-morbid illness in COPD patients receiving maintenance treatment in a real world setting.Methods: In a single visit, patients with a physician's diagnosis of COPD who were receiving monotherapy with a long-acting bronchodilator (LABD) performed spirometry, completed symptom questionnaires, and reported their treatments, history of exacerbations and co-morbidities. Results:We enrolled 1084 patients of whom 1072 had acceptable spirometry. 689 (64%) had airflow obstruction (FEV1/FVC≤0.70) while 383 (36%) failed to meet spirometric criteria for COPD despite receiving maintenance therapy and having comparable symptoms and comorbid illness. Among those with confirmed COPD, dyspnoea was worse in those with more severe airflow limitation though exacerbation frequency was comparable across COPD stages.Conclusions: COPD is commonly diagnosed and treated in patients without airflow obstruction. Many COPD patients receiving LABD monotherapy continue to suffer significant symptoms, exacerbations and poor quality of life.

A Network Meta-Analysis of Long-Acting Muscarinic Antagonist (LAMA) and Long-Acting β2-Agonist (LABA) Combinations in COPD

“…Included trials were required to report outcomes within a 4-week window at 12 (8)(9)(10)(11)(12)(13)(14)(15)(16) weeks and/or 24 (20)(21)(22)(23)(24)(25)(26)(27)(28) weeks. Outcomes of interest were: trough forced expiratory volume in 1 s (FEV 1 ), and the subjective PROs of breathlessness assessed by the Transition Dyspnea Index (TDI) focal score, health-related quality of life (HRQoL) assessed by the St George's Respiratory Questionnaire (SGRQ) total score, and rescue short-acting b 2 -agonist medication use (puffs/day).…”

“…Despite the well-demonstrated utility of LABAs [4][5][6][7] and LAMAs [8][9][10][11] as maintenance therapy, a high number of patients with moderate or severe COPD receiving LABA or LAMA monotherapy can fail to achieve adequate control of symptoms [12]. A combination of a LAMA and a LABA maintenance therapy is a logical therapeutic option to improve symptom control for such patients [13].…”

Triple Therapy of Umeclidinium + Inhaled Corticosteroids/Long-Acting Beta2 Agonists for Patients with COPD: Pooled Results of Randomized Placebo-Controlled Trials

“…Bronchodilators [e.g., long-acting beta 2 agonists (LABAs) and long-acting muscarinic antagonists (LAMAs)] are central to the pharmacological management of symptomatic COPD [1]. However, use of bronchodilator monotherapy is frequently associated with ongoing dyspnea [2].…”

“…Bronchodilators [e.g., long-acting beta 2 agonists (LABAs) and long-acting muscarinic antagonists (LAMAs)] are central to the pharmacological management of symptomatic COPD [1]. However, use of bronchodilator monotherapy is frequently associated with ongoing dyspnea [2]. Combining two bronchodilators with different mechanisms of action could increase bronchodilation with equivalent or fewer side effects compared with increasing the dose of a single agent [1].…”

Umeclidinium/Vilanterol Versus Tiotropium/Olodaterol in Maintenance-Naïve Patients with Moderate Symptomatic Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis

“…A majority of patients who receive LAMA or LABA monotherapy continue to experience ongoing moderate-to-severe dyspnea, regardless of the level of lung function impairment [6], and this symptom persistence can be associated with poor health status, as well as a higher risk for moderate and severe exacerbations and augmented disease management costs [7,8]. There is now a large body of evidence to show that LAMA/LABA combinations consistently improve lung function, breathlessness and health status with no increased incidence of adverse events (AEs), compared with either LABA or LAMA alone [4,[9][10][11][12][13][14][15].…”