Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study

Jenkins, Christine; Jones, Paul; Calverley, Peter M.A.; Celli, Bartolomé R.; Anderson, Julie A.; Ferguson, Gary T.; Yates, Julie; Willits, Lisa; Vestbo, Jørgen

doi:10.1186/1465-9921-10-59

Cited by 302 publications

(266 citation statements)

References 14 publications

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“…Large clinical trials have already documented the benefit of longacting bronchodilators, in terms of lung function, health status, hospitalisation, exacerbation rates, and mortality. [12][13][14][15] In the present study, the overall use of LABA and LAMA were only about 17% and 7%, respectively. This inappropriately low prescription rate of long-acting bronchodilators had also been demonstrated in a previous local study.…”

Section: Discussionmentioning

confidence: 99%

Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital

Au¹,

Chan²

2013

Hong Kong Med J

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Objective To assess the disease spectrum, severity of airflow limitation, admission pattern, co-morbidities, and management of patients admitted for acute exacerbations of chronic obstructive pulmonary disease. Design Case series.Setting An acute regional hospital in Hong Kong.Patients Adult subjects admitted during January 2010 to December 2010 with the principal discharge diagnosis of chronic obstructive pulmonary disease. ResultsIn all, the records of 253 patients with physician-diagnosed chronic obstructive pulmonary disease were analysed. The majority were old (mean age, 78 years). The median number of admissions per patient for this condition in 2010 was two. About two thirds (64%) had had spirometry at least once. Mean forced expiratory volume in one second predicted was 55%. Almost 90% had moderate-to-very severe airflow limitation by spirometry. Overall, long-acting bronchodilators (beta agonists and/or antimuscarinics) were being prescribed for only 21% of the patients. ConclusionMost of the patients admitted to hospital for acute exacerbations of chronic obstructive pulmonary disease were old, had multiple co-morbidities, and the majority had moderate-to-severe airflow limitation by spirometry. Almost half of them (around 46%) had two or more admissions in 2010. Adherence to the latest treatment guidelines seemed inadequate, there being a low prescription rate of long-acting bronchodilators. Chronic obstructive pulmonary disease patients warranting emergency admissions are at risk of future exacerbations and mortality. Management by a designated multidisciplinary team is recommended. Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital O R I G I N A L A R T I C L E LH Au HS Chan 區力行陳學深New knowledge added by this study • Almost 90% of chronic obstructive pulmonary disease (COPD) subjects with spirometry performed had moderate-to-very severe disease when hospital admission ensued. • About half of these patients had two or more admissions in 1 year.• Despite the severity of their illness, long-acting bronchodilators were underused by these Hong Kong COPD patients.• Long-term oxygen therapy and non-invasive ventilation (acute and long term) were used by significant numbers of patients with severe-to-very severe disease. Implications for clinical practice or policy• As many COPD patients warranting hospital admissions were already at high risk, preferably they should be managed by a multidisciplinary team in a designated respiratory or COPD ward.• Patients with a clinical diagnosis of COPD should have confirmatory spirometry.• Patients with moderate-to-severe COPD disease warrant planned interventions (including use of long-acting bronchodilators) to reduce future exacerbations and hospital admissions.• COPD patients with hypercapnic respiratory failure are at risk of mortality, and if feasible, should be managed by trained staff in a dedicated team.

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Section: Discussionmentioning

confidence: 99%

Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital

Au¹,

Chan²

2013

Hong Kong Med J

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“…For example, a post hoc analysis examined the effects of salmeterol/fluticasone combination therapy by disease stage focusing on moderate COPD. 26 In patients with moderate COPD, this analysis showed significant improvement in post-bronchodilator FEV1 and health status, and a reduction in exacerbation rates compared to placebo. Another post hoc analysis focusing on those with moderate disease, showed better health status and longer time to first exacerbation in the group treated with tiotropium compared to placebo.…”

Section: Introductionmentioning

confidence: 81%

Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care

Joo

Fitzgibbon

et al. 2011

J GEN INTERN MED

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BACKGROUND: It is unclear if primary care physicians are following guidelines or using other patient characteristics and factors to determine when to perform spirometry in patients at risk for COPD. It is also unclear to what degree a diagnosis of COPD is accurately reflected by spirometry results. OBJECTIVES: To examine characteristics associated with use of spirometry in primary care for patients with increased risk for COPD and to determine the accuracy of COPD diagnosis in patients with spirometry. DESIGN: Retrospective cohort study. were not associated with use of spirometry. Of the 159 patients with a diagnosis of COPD, 93 (58.5%) met GOLD criteria and 81(50.9%) met lower limit of normal (LLN) criteria for COPD. CONCLUSION: Clinicians use spirometry more often among patients with symptoms suggestive of COPD but not more often among patients with current or past tobacco use. For patients who had a spirometry and a diagnosis of COPD, primary care physicians were accurate in their diagnosis only half of the time.KEY WORDS: chronic disease; diagnosis; health care delivery; chronic obstructive pulmonary disease; spirometry; quality of care.

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“…Hyperinflation impacts upon a patient's inspiratory capacity, increases functional residual capacity and limits exercise capability [1]. Similarly, post hoc analyses of data from the TORCH (Towards a Revolution in COPD Health), UPLIFT (Understanding Potential Long-term Impacts on Function with Tiotropium) and ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) studies found that pulmonary function decline is faster in the earlier stages of disease [10][11][12][13].…”

Section: Rationale For Early Treatmentmentioning

confidence: 99%

“…There is evidence that lung function, health status and dyspnoea in patients with mildto-moderate COPD can be improved with single-agent pharmacotherapy [21][22][23][24]. Subgroup analyses of clinical trials suggest that pharmacotherapy may also reduce the rate in forced expiratory volume in 1 s (FEV1) decline versus placebo in patients with early stages of the disease [11,12,25]. Therefore, we speculate that intervention with long-acting bronchodilators at an early stage in disease could prove beneficial and may improve patient-reported outcomes.…”

Section: Rationale For Early Treatmentmentioning

confidence: 99%

Addressing unmet needs in the treatment of COPD

Patalano¹,

Banerji²,

D’Andrea³

et al. 2014

European Respiratory Review

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The burden of chronic obstructive pulmonary disease (COPD) is considerable, both socially and economically. Central to COPD management is the use of long-acting bronchodilators, which provide patients with optimal bronchodilation and improvements in symptoms. The once-daily, long-acting b 2 -agonist indacaterol, the long-acting muscarinic antagonist glycopyrronium, and the indacaterol/glycopyrronium fixed-dose combination QVA149 have all been shown to significantly improve lung function and patientreported outcomes. The ability to take medication appropriately is important. Easy to use, low resistance devices may help patients take their medication and achieve good drug deposition. There is a need to optimise COPD management by treating the right patients with the right therapy at the right time during the course of their disease. Herein, we present a view on the current COPD management landscape and current unmet needs, and look to the future of COPD treatment and how patient care can be optimised. @ERSpublications There is a need to optimise COPD treatment, with the aim of improving patients' lives

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Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study

Cited by 302 publications

References 14 publications

Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital

Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital

Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care

Addressing unmet needs in the treatment of COPD

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