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).

IF 5.8 2区 医学 Q1 Medicine Respiratory Research Pub Date : 2024-10-17 DOI:10.1186/s12931-024-02971-3
Yu-Ting Lai, Ying-Huang Tsai, Meng-Jer Hsieh, Ning-Hung Chen, Shih-Lung Cheng, Chi-Wei Tao, Yu-Feng Wei, Yao-Kuang Wu, Ming-Cheng Chan, Shih-Feng Liu, Wu-Huei Hsu, Tsung-Ming Yang, Ching-Lung Liu, Ping-Hung Kuo, Ming-Shian Lin
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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.

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在实际临床实践中,双重支气管扩张剂疗法对慢性阻塞性肺病患者病情加重的益处:一项多中心验证研究(TOReTO)。
背景:事实证明,由长效β-受体激动剂(LABA)和长效毒蕈碱拮抗剂(LAMA)组成的双重支气管扩张剂疗法对慢性阻塞性肺病(COPD)患者有效。然而,目前仍不确定慢性阻塞性肺病患者中目前吸烟者和曾经吸烟者之间是否存在疗效差异。本研究旨在探讨 LABA/LAMA 疗法对这两类患者的疗效:TOReTO试验评估了肺功能、症状、健康状况、恶化发生率、临床显著恶化以及LABA/LAMA疗法的使用情况。这些疗法包括用于慢性阻塞性肺病患者的 Tio/Olo、优立定/维兰特罗(Umec/Vi)和优立定/维兰特罗(Umec/Vi)。该研究考察了当前吸烟者和曾经吸烟者的治疗效果差异。为了平衡基线特征,研究采用了倾向得分匹配法(PSM):研究收集了 967 名患者的数据。经过倾向得分匹配后,分别分析了三个治疗组的当前吸烟者首次急性加重的时间,结果发现他们之间存在显著差异(p = 0.0457)。其中,Umec/Vi 的急性加重发生率在治疗和吸烟状态之间存在差异(p = 0.0114)。LABA/LAMA 固定剂量组合的三个不同组别在治疗前吸烟者方面没有明显差异(p = 0.3079)。在整个治疗期间,慢性阻塞性肺疾病相关症状保持稳定。研究结束时,三组患者的症状评分(包括CAT和mMRC)无明显差异:结论:LABA/LAMA的三种固定剂量组合在减少曾经吸烟者的病情恶化方面没有差异,但在目前吸烟者中确实存在差异。这一趋势具有临床意义,今后的研究将通过控制影响变量来验证这一点。然而,由于该研究采用的是非随机研究设计,因此在解释这些结果时应谨慎。
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来源期刊
Respiratory Research
Respiratory Research RESPIRATORY SYSTEM-
CiteScore
9.70
自引率
1.70%
发文量
314
审稿时长
4-8 weeks
期刊介绍: Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.
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