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Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD
Sae Ahm Kim1, Ji-Hyun Lee2, Eun-Kyung Kim2
1Department of Internal Medicinem, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Tuberculosis and Respiratory Diseases
|January 16, 2016
Summary
Caution is advised when reducing inhalers for chronic obstructive pulmonary disease (COPD) patients on triple therapy. Step-down may worsen symptoms, reduce quality of life, and accelerate lung function decline.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Triple therapy (inhaled corticosteroid, long-acting muscarinic antagonist, long-acting β2-agonist) is common for chronic obstructive pulmonary disease (COPD).
- Step-down therapy involves reducing the number of inhalers used in COPD management.
- Outcomes of single inhaler withdrawal from triple therapy in COPD are not well-documented.
Purpose of the Study:
- To evaluate the clinical outcomes after a single inhaler withdrawal (step-down) in patients with COPD on triple therapy.
- To compare patients undergoing step-down therapy with those continuing triple therapy.
Main Methods:
- Retrospective observational study comparing a step-down group (n=39) with a triple therapy group (n=109).
- Patients in the step-down group initiated withdrawal after at least 1 year of triple therapy.
- Index time was defined as withdrawal time for the step-down group and 1 year after triple therapy initiation for the triple group.
Main Results:
- The step-down group had better baseline lung function and lower prior exacerbation rates.
- Step-down therapy led to worsened disease symptoms, reduced quality of life, and decreased exercise performance.
- A significant acceleration in forced expiratory volume in 1 second (FEV1) decline was observed in the step-down group (54.7 mL/yr vs. 10.7 mL/yr).
- No significant increase in exacerbation frequency was noted post-step-down.
Conclusions:
- Withdrawal of a single inhaler from triple therapy in COPD patients requires caution.
- Step-down therapy may negatively impact exercise capacity and quality of life.
- Accelerated decline in FEV1 is a potential consequence of inhaler withdrawal in COPD patients on triple therapy.
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