How can the findings of the EMAX trial on long-acting bronchodilation in chronic obstructive pulmonary disease be applied in the primary care setting?

IF 3.5 3区 医学 Q2 RESPIRATORY SYSTEM Chronic Respiratory Disease Pub Date : 2023-01-01 DOI:10.1177/14799731231202257
Edward M Kerwin, Paul W Jones, Leif H Bjermer, François Maltais, Isabelle H Boucot, Ian P Naya, David A Lipson, Chris Compton, Lee Tombs, Claus F Vogelmeier
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Abstract

This review addresses outstanding questions regarding initial pharmacological management of chronic obstructive pulmonary disease (COPD). Optimizing initial treatment improves clinical outcomes in symptomatic patients, including those with low exacerbation risk. Long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) dual therapy improves lung function versus LAMA or LABA monotherapy, although other treatment benefits have been less consistently observed. The benefits of dual bronchodilation in symptomatic patients with COPD at low exacerbation risk, and its duration of efficacy and cost effectiveness in this population, are not yet fully established. Questions remain on the impact of baseline symptom severity, prior treatment, degree of reversibility to bronchodilators, and smoking status on responses to dual bronchodilator treatment. Using evidence from EMAX (NCT03034915), a 6-month trial comparing the LAMA/LABA combination umeclidinium/vilanterol with umeclidinium and salmeterol monotherapy in symptomatic patients with COPD at low exacerbation risk who were inhaled corticosteroid-naïve, we describe how these findings can be applied in primary care.

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EMAX关于慢性阻塞性肺病长效支气管扩张的试验结果如何应用于初级保健环境?
这篇综述解决了关于慢性阻塞性肺病(COPD)初始药物治疗的悬而未决的问题。优化初始治疗可以改善有症状患者的临床结果,包括那些病情恶化风险较低的患者。与LAMA或LABA单药治疗相比,长效毒蕈碱拮抗剂/长效β2-拮抗剂(LAMA/LABA)双重治疗可改善肺功能,尽管其他治疗益处尚未得到一致观察。双重支气管扩张在低恶化风险的COPD症状患者中的益处,以及在该人群中的有效期和成本效益,尚未完全确定。基线症状严重程度、既往治疗、支气管扩张剂的可逆性程度和吸烟状况对双支气管扩张剂治疗反应的影响仍存在疑问。使用来自EMAX(NCT03034915)的证据,我们描述了这些发现如何应用于初级保健。EMAX是一项为期6个月的试验,比较了LAMA/LABA组合umeclidinium/vilantol与umeclidinium和沙美特罗单药治疗吸入皮质类固醇的低恶化风险COPD症状患者。
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来源期刊
Chronic Respiratory Disease
Chronic Respiratory Disease RESPIRATORY SYSTEM-
CiteScore
5.90
自引率
7.30%
发文量
47
审稿时长
11 weeks
期刊介绍: Chronic Respiratory Disease is a peer-reviewed, open access, scholarly journal, created in response to the rising incidence of chronic respiratory diseases worldwide. It publishes high quality research papers and original articles that have immediate relevance to clinical practice and its multi-disciplinary perspective reflects the nature of modern treatment. The journal provides a high quality, multi-disciplinary focus for the publication of original papers, reviews and commentary in the broad area of chronic respiratory disease, particularly its treatment and management.
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