The effects of different inhalation therapies on less symptomatic chronic obstructive pulmonary disease patients in a Chinese population: a real-world study

Abstract

Background The Global Initiative for Chronic Obstructive Lung Disease (GOLD) document suggests that patients with chronic obstructive pulmonary disease (COPD) should be divided into a less symptomatic group. Moreover, single-inhaled drugs are recommended as initial inhalation therapy for them. However, many less symptomatic patients are provided double or triple-inhaled drugs as initial therapy in the real world. This study aimed to describe the inhalation prescriptions and compare the effects of different inhalation therapies on less symptomatic COPD patients. Patients and methods This was an observational study. Stable COPD patients were recruited and divided into a less symptomatic group including Groups A and C based on the GOLD 2019 document. We collected the data of inhalation therapies prescriptions. Then, the patients were classified into long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS groups. All the patients were followed up for 1 year to collect exacerbation and mortality data. Results We found that only 45.4% of patients in Group A and 43.6% of patients in Group C received reasonable inhalation therapy in reference to the GOLD document. In addition, the LAMA group had a higher forced expiratory volume in one second (FEV1), FEV1%pred, FEV1/forced vital capacity and peak expiratory flow compared with LABA + ICS, LABA + LAMA and LABA + LAMA + ICS groups. However, we did not find any significant differences of exacerbation, hospitalization and mortality during the follow-up among different inhalation therapies groups on less symptomatic COPD patients. Conclusion Over half of the less symptomatic patients received inhalation therapy that were inconsistent with the GOLD document recommendations in a Chinese population in the real world. In fact, the single inhaled drug of LAMA should be recommended and pulmonary function is not a good indicator for the choice of initial inhalation therapy in less symptomatic COPD patients. KEY MESSAGES Over half of the less symptomatic COPD patients received inhalation therapy that were inconsistent with the GOLD document recommendations in a Chinese population in the real world. The clinicians should offer a single inhaled drug of LAMA to less symptomatic COPD patients and pulmonary function is not a good indicator for the choice of initial inhalation therapy.

The future exacerbation and mortality of different inhalation therapies among patients with chronic obstructive pulmonary disease in various GOLD groups: a focus on the GOLD 2017 and GOLD 2023 reports

“… 18 – 19 However, our previous study found that there were no significant differences in exacerbation, hospitalization, and mortality during the follow-up among different inhalation therapies on less symptomatic COPD patients. 20 This study also confirmed that the patients in Groups A and C treated with LABA + LAMA or LABA + LAMA + ICS did not achieve better outcomes than patients treated with LAMA or LABA + ICS. Therefore, merging Groups C and D into Group E and recommending LABA + LAMA or LABA + LAMA + ICS as the initial inhalation therapy must be considered.…”

“…Finally, some studies have shown that the real-world 10 journals.sagepub.com/home/tar TherapeuTic advances in respiratory disease prescriptions of initial inhalation therapy for COPD patients were not consistent with GOLD reports and the causes including pulmonary function, poor familiarity with recommendations, low self-efficacy, and time constraints might have an influence on the future exacerbation and mortality. [20][21]…”

Comparative effectiveness and safety of triple therapy and non-triple therapy interventions for COPD: an overview of systematic reviews

“…Notably, 80% of the original studies required subjects to have a smoking history of no less than 10 pack-years, which may lead to bias in the evidence for younger patients, mild status (GOLD 1) (relevant trial is already underway 53 ), or never smokers. Despite some studies suggesting the benefit of triple therapy may not be related to age or lung function, 54 , 55 the evidence appears to be insufficient. Furthermore, a SR confirmed the absolute benefit appeared to be greater for ex-smokers; 56 however, we have not yet found whether there is a difference in benefit for never-smoking patients.…”

The Clinical Characteristics and Outcomes in Non-Frequent Exacerbation Patients with Chronic Obstructive Pulmonary Disease in the Chinese Population

“…A previous study confirmed that the future exacerbation and mortality showed no significant differences among different inhalation therapies in patients with less symptomatic COPD. 26 It implied that mono-LAMA should be recommended to the non-frequent exacerbation patients with less symptomatic COPD as the initial inhalation therapy.…”