Benefit of dual bronchodilator therapy on exacerbations in former and current smokers with chronic obstructive pulmonary disease in real-world clinical practice: a multicenter validation study (TOReTO).
Journal
Respiratory research
Journal Volume
25
Journal Issue
1
Start Page
Article number 377
ISSN
1465-993X
Date Issued
2024-10-17
Author(s)
Lai, Yu-Ting
Tsai, Ying-Huang
Hsieh, Meng-Jer
Chen, Ning-Hung
Cheng, Shih-Lung
Tao, Chi-Wei
Wei, Yu-Feng
Wu, Yao-Kuang
Chan, Ming-Cheng
Liu, Shih-Feng
Hsu, Wu-Huei
Yang, Tsung-Ming
Liu, Ching-Lung
Lin, Ming-Shian
Abstract
Background: Dual bronchodilator therapy, consisting of a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), has proven effective for patients with chronic obstructive pulmonary disease (COPD). However, it remains uncertain whether there are efficacy differences between current and former smokers with COPD. This study aims to explore the effectiveness of LABA/LAMA therapies in both these groups. Methods: The TOReTO trial assessed lung function, symptoms, health status, the occurrence of exacerbations, clinically significant exacerbations, and the use of LABA/LAMA therapies. These therapies include Tio/Olo, umeclidinium/vilanterol (Umec/Vi), and umeclidinium/vilanterol (Umec/Vi) are used in patients with COPD. The study examined the differences in outcomes between current and former smokers. To balance the baseline characteristics, propensity score matching (PSM) was employed. Results: Data from 967 patients were collected. After PSM, the time to the first acute exacerbation in current smokers was analyzed separately for the three treatment groups and was significantly different between them (p = 0.0457). Among, there are differences in the occurrence of acute exacerbation between treatment and smoking status in Umec/Vi (p = 0.0114). There is no significant difference in the treatment of former smokers among the three different groups of LABA/LAMA fixed-dose combinations (p = 0.3079). COPD-related symptoms remained stable throughout the treatment period. There were no significant differences in symptom scores, including CAT and mMRC, among the three groups at the end of the study. Conclusions: The three fixed-dose combinations of LABA/LAMA showed no difference in reducing exacerbations in former smokers but did show differences in current smokers. This trend has clinical significance, and future research will be conducted to control influencing variables to validate this point. However, due to the non-randomized study design, these findings should be interpreted with caution.
Subjects
CAT scores
Chronic obstructive pulmonary disease
Exacerbation rates
FEV1
Long-acting beta-agonist (LABA)/long-acting muscarinic antagonist (LAMA)
mMRC scores
SDGs
Type
journal article