Long-acting bronchodilators improve Health Related Quality of Life in patients with COPD

Braido, Fulvio; Baiardini, Ilaria; Cazzola, Mario; Brusselle, Guy; Marugo, Fiorenza; Canonica, Giorgio Walter

doi:10.1016/j.rmed.2013.08.007

Cited by 17 publications

(8 citation statements)

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“…Commonly used instruments, like SGRQ, CAT, or Transition Dyspnea Index, lack certain domains of great DOI: 10.1159/000491673 importance to patients with COPD, such as mobility, fatigue, anxiety, depression, social functioning, and sleep. We pointed out this aspect in a previous review about HRQoL/HS outcomes with long-acting bronchodilators in COPD, but the goal still needs to be reached [4]. This issue could be solved by the usage of a standardized set of tools to assess also these important PROs domains.…”

Section: Discussionmentioning

confidence: 99%

“…Both long-acting beta 2-agonist (LABA) and long-acting muscarinic antagonist (LAMA) are effective as monotherapies and have acceptable safety profiles [2,3]. They also significantly improve Health Related Quality of Life (HRQoL) and Health Status (HS), but in many cases, this change is below the Minimally Important Difference (MID) [4]. Symptomatic, not adequately controlled patients on a single long-acting bronchodilator, may benefit from the treatment of the combined use of 2 bronchodilators (LABA/LAMA) with distinct mechanisms of action.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies with LABA/LAMA focused primarily on the improvement in lung function, and less attention has been paid to HRQoL and HS [14][15][16]. However, lung function improvement does not correlate strongly with HRQoL and HS, although functional improvement of clinical parameters implies such a relationship [4]. Patient Reported Outcomes (PROs) [17], such as HRQoL and HS, represent the patient perspective and therefore a relevant outcome.…”

Section: Introductionmentioning

confidence: 99%

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LABA/LAMA Fixed Dose Combination in Chronic Obstructive Pulmonary Disease: The Impact on Health-Related Quality of Life

et al. 2018

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Background: While fixed dose combinations (FDCs) of long-acting beta 2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are increasingly tested on their efficacy in improving lung function, their effectiveness on Patient Reported Outcomes (PROs) such as Health Related Quality of Life (HRQoL) and Health Status (HS) deserve more attention. Objectives: To review current available evidence about the treatment effect of fixed LABA/LAMA FDCs on HRQoL. Methods: A systematic literature search for randomized controlled trials (RCTs) about the impact of LABA/LAMA FDCs versus placebo, LABA or LAMA or LABA/ICS on HRQoL in Chronic obstructive pulmonary disease (COPD) patients has been performed. Results: Twenty-eight RCTs (n = 32, 165 COPD patients) investigating the impact of fixed LABA/LAMA combinations on HRQoL were included. Using the St George’ s Respiratory Questionnaire, 27 out of 28 trials assessed HRQoL. LABA/LAMA FDCs significantly improved HRQoL versus placebo in 9 out of 11 trials, while change when compared to other LABA or LAMA monocomponents was significantly better in 11 out 24. In 5 out of 6 RCTs having LABA/ICS as comparators, LABA/LAMA FDC had a similar effect and only 1 showed significant improvement in HRQL compared to LABA/ICS FDC. Conclusion: LABA/LAMA FDCs may be helpful in improving HRQoL, but because of the heterogeneity of performed trials, strong conclusions cannot be drawn. Moreover, due to the different molecule properties, treatment schedule, and device characteristics of each FDC, a generalized judgment seems inappropriate. Pragmatic trials powered to detect real-life differences in HRQoL and head-to-head comparison are needed to guide clinical practice in terms of PROs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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LABA/LAMA Fixed Dose Combination in Chronic Obstructive Pulmonary Disease: The Impact on Health-Related Quality of Life

et al. 2018

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“…We recommend the use of an inhaled long-acting bronchodilator, either LAMA or LABA monotherapy, to reduce dyspnea, improve exercise tolerance, and improve health status in stable COPD patients 32,33,37,38,40,44,[49][50][51][52][53][54][55][56][57][58][59][60] (Grade 1A). 2.…”

Section: Summary Of Evidencementioning

confidence: 99%

CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: Since the last published Canadian Thoracic Society (CTS) COPD guideline in 2007 and the 2008 update -highlights for primary care, many new clinical trials have challenged COPD treatment practices. The current Canadian position statement provides the reader with an update on pharmacotherapy of patients with COPD as reviewed by the CTS. OBJECTIVES: The objectives of this position statement are: 1) to summarize the literature on topics relevant to the pharmacological therapy of patients with stable COPD; and 2) to provide clinical guidance with evidence-based recommendations and expert-informed key messages for the pharmacological therapy for patients with stable COPD. METHODS: The authors systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert-informed opinion, were agreed upon by a majority consensus. MAIN RESULTS: There is typically a significant delay in seeking medical care by patients with dyspnea, often waiting until symptoms affect the performance of activities of daily living. The diagnosis of COPD requires spirometry to confirm the presence of airflow obstruction in any patient presenting with symptoms and/or risk factors of COPD. An effective management plan for individuals with COPD should include: smoking cessation, vaccination and education. A number of non-pharmacological treatments are available for COPD patients with symptoms to improve outcomes such as self-management with coaching from a health care professional; pulmonary rehabilitation; supplemental oxygen in selected patients; and surgery.Current pharmacotherapy for COPD has been shown to alleviate symptoms and prevent exacerbations and related complications such as hospital admissions. In symptomatic patients with stable COPD not having or having infrequent exacerbation, treatment should be started with inhaled LAMA or LABA monotherapy, and if experiencing persistent or increased dyspnea, exercise intolerance, and/or reduced health status despite use of monotherapy, patients should be considered for treatment "step up" with an inhaled LAMA plus LABA dual therapy. In this situation, the use of a single inhaler would be preferred to simplify the treatment regimen and minimize the cost. In patients with stable COPD experiencing exacerbations despite the use of LAMA or LABA monotherapy, treatment "step up" with inhaled LAMA plus LABA dual therapy should be considered unless a patient has concomitant asthma (Asthma/COPD overlap (ACO)). There has been recent interest in using biomarkers to identify patients who are more likely to respond to ICS. Most of the studies have demonstrated that high blood eosinophils could be valuable to predict an increase response in terms of reduction of exacerbation rate when treated with combination ICS/LABA; there is still uncertainty about the exact cut-off level of blood eosinophils having potential therapeutic value. If a pa...

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“…19e21 LABAs also may improve health-related quality of life in patients with COPD. 22 There are also the long-acting muscarinic (anticholinergic) antagonists (LAMAs) tiotropium bromide (DPI and soft mist inhaler), aclidinium bromide (DPI), and glycopyrronium bromide (DPI). Clinical studies have shown these inhaled therapies to be both effective and well-tolerated when used alone.…”

Section: Unmet Medical Needs For Copd Patients In Pa/ltc Settingsmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease in Post-acute/Long-term Care Settings: Seizing Opportunities to Individualize Treatment and Device Selection

Patel

Steinberg

Suarez-Barcelo

et al. 2017

Journal of the American Medical Directors Association

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Long-acting bronchodilators improve Health Related Quality of Life in patients with COPD

Abstract: The data coming from the review support the efficacy of long acting bronchodilators in improving HRQoL/HS of COPD patients. Further research evaluating HRQoL/HS as primary outcome and according to guidelines on Patient Reported Outcomes is needed.

Cited by 17 publications

References 80 publications

LABA/LAMA Fixed Dose Combination in Chronic Obstructive Pulmonary Disease: The Impact on Health-Related Quality of Life

LABA/LAMA Fixed Dose Combination in Chronic Obstructive Pulmonary Disease: The Impact on Health-Related Quality of Life

CTS position statement: Pharmacotherapy in patients with COPD—An update

Chronic Obstructive Pulmonary Disease in Post-acute/Long-term Care Settings: Seizing Opportunities to Individualize Treatment and Device Selection

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