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Research ArticleOriginal Research

Therapeutic Response to Single-Inhaler Triple Therapies in Moderate-to-Severe COPD

Kengo Ohtsuka, Naoko Harada, Atsuo Horiuchi, Shintaro Umemoto, Ryo Kurabatashi, Akie Yui, Hiroyuki Yamamura, Yoko Shinka and Naoki Miyao
Respiratory Care March 2023, 68 (3) 330-337; DOI: https://doi.org/10.4187/respcare.10188
Kengo Ohtsuka
Department of Internal Medicine, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
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Naoko Harada
Department of Internal Medicine, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
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Atsuo Horiuchi
Department of Internal Medicine, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
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Shintaro Umemoto
Department of Internal Medicine, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
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Ryo Kurabatashi
Department of Internal Medicine, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
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Akie Yui
Department of Internal Medicine, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
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Hiroyuki Yamamura
Department of Internal Medicine, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
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Yoko Shinka
Department of Internal Medicine, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
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Naoki Miyao
Department of Internal Medicine, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: COPD is characterized by progressive and irreversible air flow limitations. Single-inhaler therapies (SITTs) incorporating an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting β2-agonist have been shown to effectively alleviate symptoms and improve lung function. Fluticasone-furoate/umeclidinium/vilanterol (F/U/V) and budesonide/glycopyrronium/formoterol (B/G/F) are available as SITT in Japan. However, the clinical differences between these 2 combinations and the predictors of their proper use have not been established. This study aimed to identify the subject characteristics that could predict the effectiveness of inhaler therapy.

METHODS: We assessed the pulmonary function test results of subjects with COPD before and one month after using F/U/V and B/G/F as SITT. Subjects with a difference of 100 mL or more in the FEV1 after treatment with pre-SITT were extracted and divided into the F/U/V effect and no-effect group and B/G/F effect and no-effect group to examine the factors associated with positive outcomes with each inhaler.

RESULTS: F/U/V and B/G/F significantly improved the inspiratory capacity (IC), %IC, FVC, and %FEV1 when compared to pre-intervention values (P < .001, P = .001, P = .007, P = .009, respectively, for F/U/V; and P = .006, P = .008, P = .038, P = .005, respectively, for B/G/F). Factors associated with FEV1 improvement in F/U/V included lower %IC (odds ratio 0.97 [95% CI 0.94–0.99], P = .03) and a higher modified Medical Research Council (mMRC) dyspnea score (2.36 [1.27–4.70], P < .01). In addition, a higher %IC (1.03 [1.00–1.06], P = .02) and lower mMRC dyspnea score (0.55 [0.28–0.99], P = .041) were predictors for the effectiveness of B/G/F.

CONCLUSIONS: Our results showed that SITT significantly improved the IC, %IC, FVC, and %FEV1 when compared to pre-intervention and that F/U/V was more effective in subjects with severe symptoms, whereas B/G/F was more effective in subjects with mild symptoms.

  • COPD
  • fluticasone-furoate/umeclidinium/vilanterol
  • budesonide/glycopyrrolate/formoterol
  • inspiratory capacity
  • modified Medical Research Council

Footnotes

  • Correspondence: Naoki Miyao, Nippon Koukan Hospital, Kanagawa, Japan, 1–2-1 Koukandori, Kawasaki-ku, Kanagawa 210-0852, Japan. E-mail: naoki-miyao{at}koukankai.or.jp
  • The authors have disclosed no conflicts of interest.

  • Clinical trial registration number: UMIN000041089.

  • Copyright © 2023 by Daedalus Enterprises
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Respiratory Care: 68 (3)
Respiratory Care
Vol. 68, Issue 3
1 Mar 2023
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Therapeutic Response to Single-Inhaler Triple Therapies in Moderate-to-Severe COPD
Kengo Ohtsuka, Naoko Harada, Atsuo Horiuchi, Shintaro Umemoto, Ryo Kurabatashi, Akie Yui, Hiroyuki Yamamura, Yoko Shinka, Naoki Miyao
Respiratory Care Mar 2023, 68 (3) 330-337; DOI: 10.4187/respcare.10188

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Therapeutic Response to Single-Inhaler Triple Therapies in Moderate-to-Severe COPD
Kengo Ohtsuka, Naoko Harada, Atsuo Horiuchi, Shintaro Umemoto, Ryo Kurabatashi, Akie Yui, Hiroyuki Yamamura, Yoko Shinka, Naoki Miyao
Respiratory Care Mar 2023, 68 (3) 330-337; DOI: 10.4187/respcare.10188
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Keywords

  • COPD
  • fluticasone-furoate/umeclidinium/vilanterol
  • budesonide/glycopyrrolate/formoterol
  • inspiratory capacity
  • modified Medical Research Council

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