Long‑acting muscarinic antagonist and long‑acting β2‑agonist therapy to optimize chronic obstructive pulmonary disease prior to lung cancer surgery

Abstract

Bronchodilators are essential for the perioperative management of patients with chronic obstructive pulmonary disease (COPD) undergoing surgery for lung cancer. The objective of the present study was to examine whether the usage of a long-acting β2-agonist (LABA) with a long-acting muscarinic antagonist (LAMA) could optimize preoperative lung function and reduce the risk for postoperative pulmonary complications. Thirty-two consecutive patients with moderate-to-severe COPD who underwent a lobectomy for lung cancer and received preoperative LAMA (n=19) or LAMA/LABA (n=13) therapy between January 2005 and December 2015 were enrolled in this retrospective study. The improvement of preoperative pulmonary function and the postoperative morbidity were compared between the patients with preoperative LAMA, and LAMA/LABA therapy. Increases in the forced expiratory volume in one second (FEV) were significantly larger in the LAMA/LABA group than in the LAMA group (0.26±0.05 l vs. 0.07±0.05 l; P=0.0145). More patients in the LAMA/LABA group than in the LAMA group showed a marked improvement of >10% in %FEV after bronchodilators (85 vs. 32%; P=0.0046). The incidence of postoperative pneumonia was significantly lower in the LAMA/LABA group than in the LAMA group (0 vs. 26%; P=0.044). In conclusion, the present study showed that preoperative LAMA/LABA therapy was associated with larger improvements in preoperative pulmonary function and less postoperative pneumonia than LAMA therapy. These results may lead to greater improvements in FEV and less postoperative pneumonia by encouraging preoperative LAMA/LABA therapy in this patient population.

Effect of perioperative bronchodilator therapy on postoperative pulmonary function among lung cancer patients with COPD

“…Instead, we used the results of baseline lung function tests that were obtained before the initiation of bronchodilator therapy in patients who just began the treatment. Considering that the majority of our patients with COPD newly began the bronchodilator treatment, we assumed that reduced postoperative lung function decline observed in the group treated with perioperative bronchodilators might be attributable to a significant increase in FEV 1 before surgical resection, as a combined effect of newly prescribed bronchodilator treatment and smoking cessation, based on previous studies 13 , 15 . In addition, we did not have data on the compliance or inhaling techniques applied during bronchodilator therapy, but we assumed that compliance rates were good before surgical resection, leading to greater benefits.…”

“…Bronchodilators, which significantly improve respiratory symptoms and lung function, are the mainstay of the management of stable COPD 11 , 12 . A couple of studies have shown that preoperative treatment with bronchodilators significantly increased predicted postoperative pulmonary functions in untreated COPD patients with lung cancer, and some of the patients were eventually able to undergo surgical resection 13 – 15 . Another study in 20 patients with COPD showed that bronchodilator therapy with tiotropium and salmeterol improved lung function and quality of life at 1 year after surgical resection, compared to a control group 16 .…”

Prognostic and functional impact of perioperative LAMA/LABA inhaled therapy in patients with lung cancer and chronic obstructive pulmonary disease

“…The utility of perioperative bronchodilator therapy has been validated in several previous reports, but the most suitable agent has not been clarified. We previously analyzed the data of 32 patients with moderate to severe COPD and lung cancer and reported that perioperative LAMA/LABA therapy improves lung function and reduces postoperative complications to a greater degree than LAMA therapy [ 13 ]. In the present study, we assessed 130 patients with COPD of all severity levels, with similar results.…”

Prognostic and Functional Impact of Perioperative LAＭA/LABA Inhaled Therapy In Patients With Lung Cancer and Chronic Obstructive Pulmonary Disease 

“…Combined LAMA/LABA therapy achieves bronchodilation through different mechanisms: the muscarinic antagonist blocks acetylcholine-mediated bronchoconstriction by binding to M 3 receptors in the smooth muscle of the airway [9], and the β 2 agonist induces relaxation of the smooth muscle by stimulating β 2 -adrenergic receptors [9]. We previously analyzed the data of 32 patients with moderate to severe COPD and lung cancer and reported that perioperative LAMA/LABA therapy improves lung function and reduces postoperative complications to a greater degree than LAMA therapy [11]. In the present study, we assessed 130 patients with COPD of all severity levels, with similar results.…”