International journal of chronic obstructive pulmonary disease
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Int J Chron Obstruct Pulmon Dis · Jan 2018
ReviewTriple therapy (ICS/LABA/LAMA) in COPD: time for a reappraisal.
Recently, two "fixed triple" single-inhaler combinations of an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA) have become available for patients with COPD. This review presents the clinical evidence that led to the approval of these triple therapies, discusses the role of ICS in patients with COPD, and presents data on the relative efficacy of "fixed triple" (ICS/LAMA/LABA) therapy vs LAMA, ICS/LABA, and LAMA/LABA combinations, and summarizes studies in which ICS/LABAs were combined with LAMAs to form "open triple" combinations. Of the five main fixed triple studies completed so far, three evaluated the efficacy and safety of an extrafine formulation of beclometasone dipropionate, formoterol fumarate, and glycopyrronium; the other two studies evaluated fluticasone furoate, vilanterol, and umeclidinium. ⋯ Furthermore, triple therapy showed a promising signal in terms of improved survival. The evidence suggests that triple therapy is the most effective treatment in moderate/severe symptomatic patients with COPD at risk of exacerbations, with marginal if any risk of side effects including pneumonia. Ongoing studies are examining the role of triple therapy in less severe symptomatic patients with COPD and asthma-COPD overlap.
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Int J Chron Obstruct Pulmon Dis · Jan 2018
Randomized Controlled Trial Multicenter Study Comparative StudyUse of a 4-week up-titration regimen of roflumilast in patients with severe COPD.
The oral selective phosphodiesterase-4 inhibitor roflumilast (ROF) reduces exacerbations in patients with severe COPD. Adverse events (AEs) can cause early ROF discontinuation. Alternative dosing strategies may help patients continue their therapy. ⋯ A dose of ROF 250 µg OD for 4 weeks before escalation to the approved maintenance dose of 500 µg OD resulted in reduced treatment discontinuation and improved tolerability.
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Int J Chron Obstruct Pulmon Dis · Jan 2018
Trends in intensive care unit admissions of COPD patients from 2003 to 2013 in Taiwan.
The objective of this study was to investigate the trends in COPD patients admitted to the intensive care unit (ICU) in Taiwan from 2003 to 2013. ⋯ The number of COPD patients admitted to the ICU in Taiwan increased over the 11-year study period. Increased mean patient age, length of ICU stays, hospital mortality, and comorbidities were observed. The use of a nationwide population-based database allowed for a sufficient sample size, generalizability, and statistical power to analyze COPD patients admitted to the ICU in Taiwan.
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Int J Chron Obstruct Pulmon Dis · Jan 2018
Randomized Controlled TrialSatisfaction, preference and error occurrence of three dry powder inhalers as assessed by a cohort naïve to inhaler operation.
Inhaled medication is central to the treatment of COPD. Various types of inhaler devices, which directly deliver medication to the lung, have been developed. However, patients often exhibit incorrect techniques of inhaler usage. Effectiveness of therapy may be affected by the ease of device usage, size, convenience of use, durability, clarity of instructions and device preferences of patients. This study compares the satisfaction and preference, as well as error occurrence, with the use of Genuair®, Ellipta™ and Breezhaler™ by healthy subjects in Hong Kong. ⋯ Breezhaler seemed to be more comfortable and easy to carry, but users made less critical errors when using Ellipta after reading the instructions only. Genuair provided the clearest indication of correct dose preparation and inhalation.
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Int J Chron Obstruct Pulmon Dis · Jan 2018
Incidence and risk of chronic obstructive pulmonary disease in a Korean community-based cohort.
COPD is a leading cause of morbidity and mortality. However, few studies have used spirometry to investigate its incidence, especially in Asia. In the present study, we analyzed the incidence and risk factors of COPD using a community cohort database in Korea. ⋯ In Korea, 15.5/1,000 people are diagnosed with COPD annually. The incidence rate increases with increasing age, heavier smoking, and decreasing income, with a higher rate in men than in women.