Dual bronchodilator treatment for prevention of <scp>COPD</scp> in at‐risk smokers

Thamrin, Cindy; Martin, Allison; Badal, Tanya; Jeagal, Edward; Cochrane, Belinda; Farah, Claude S.; King, Gregory G.; Nagarajah, Mohan; Li, Qiang; Liu, Xiaoqiu; Berend, Norbert; Jenkins, Christine

doi:10.1111/resp.14357

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…Thamrin et al identified smokers with normal spirometry but evidence of small airways disease using multiple breath nitrogen washout technique. 50 After 12 months there was no difference in any index of lung function comparing active and control treatments. In the larger RETHINC trial, 471 smokers with normal spirometry were randomized to either 12 weeks indacaterol/glycopyrrolate or placebo.…”

Section: Prevention and Treatment Summarymentioning

confidence: 85%

“…Two disappointing trials of dual BDs in smokers with preserved spirometry have been reported. Thamrin et al identified smokers with normal spirometry but evidence of small airways disease using multiple breath nitrogen washout technique 50 . After 12 months there was no difference in any index of lung function comparing active and control treatments.…”

Section: Prevention and Treatmentmentioning

confidence: 99%

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Contemporary Concise Review 2022: Chronic obstructive pulmonary disease

Calverley

Walker

2023

Respirology

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International respiratory organizations now recommend using lower limit of normal and standardized residuals to diagnose airflow obstruction and COPD though using a fixed ratio <0.7 is simpler and robustly predicts important clinical outcomes.• The most common COPD comorbidities are coronary artery calcification, emphysema and bronchiectasis. COPD patients with psychological (high anxiety and depression) and cachectic (underweight and osteoporotic) comorbidity have higher mortality and exacerbate more. • Serum eosinophil count remains an important COPD biomarker and we have greater clarity about normal eosinophil levels in COPD and the wider population. • Criteria for entry into COPD clinical trials continue to exclude many patients, in particular those at greater risk of exacerbation and death. • The effect of hyperinflation on cardiac function impacts COPD mortality and is an important target for successful lung volume reduction procedures.

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Section: Prevention and Treatment Summarymentioning

confidence: 85%

Section: Prevention and Treatmentmentioning

confidence: 99%

Contemporary Concise Review 2022: Chronic obstructive pulmonary disease

Calverley

Walker

2023

Respirology

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“…Individuals with pre-COPD may suffer dyspnoea, cough, expectoration and, sometimes, episodes of 'exacerbation of symptoms' (Figure 1). 79,85 Although these are well-recognized TTs in COPD, 1,11,25,35,41,80,86,87 so far only two recent randomized clinical trials (RCTs) 81,82 have explored the effects of treating pre-COPD symptoms with dual long-acting bronchodilators (LABA-LAMA) versus placebo. The larger one randomized 535 smokers with pre-COPD (CAT score >10 and post-bronchodilator FEV 1 /FVC ≥0.70) who were followed for 12 weeks.…”

Section: Symptomsmentioning

confidence: 99%

“…The second RCT 82 included a younger (25–55 years) group of current smokers without airflow limitation (pre‐COPD) or GOLD 1 COPD, but with abnormal multiple breath nitrogen washout as a marker of small airway dysfunction. The study duration was 12 months, much longer than the trial by Han et al, 3 but it was much smaller with only 17 in the placebo arm and 20 in the LABA‐LAMA arm completing the study.…”

Section: Treatable Traits In Pre‐copdmentioning

confidence: 99%

Treatable traits in pre‐COPD: Time to extend the treatable traits paradigm beyond established disease

Dharmage,

Faner,

Agustí

2024

Respirology

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To date, the treatable traits (TTs) approach has been applied in the context of managing diagnosed diseases. TTs are clinical characteristics and risk factors that can be identified clinically and/or biologically, and that merit treatment if present. There has been an exponential increase in the uptake of this approach by both researchers and clinicians. Realizing the potential of the TTs approach to pre‐clinical disease, this expert review proposes that it is timely to consider acting on TTs present before a clinical diagnosis is made, which might help to prevent development of the full disease. Such an approach is ideal for diseases where there is a long pre‐clinical phase, such as in chronic obstructive pulmonary disease (COPD). The term ‘pre‐COPD’ has been recently proposed to identify patients with respiratory symptoms and/or structural or functional abnormalities without airflow limitation. They may eventually develop airflow limitation with time but patients with pre‐COPD are likely to have traits that are already treatable. This review first outlines the contribution of recently generated knowledge into lifetime lung function trajectories and the conceptual framework of ‘GETomics’ to the field of pre‐COPD. GETomics is a dynamic and cumulative model of interactions between genes and the environment throughout the lifetime that integrates information from multi‐omics to understand aetiology and mechanisms of diseases. This review then discusses the current evidence on potential TTs in pre‐COPD patients and makes recommendations for practice and future research. At a broader level, this review proposes that introducing the TTs in pre‐COPD may help reenergize the preventive approaches to health and diseases.image

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