Emergency Hospital Care for Exacerbation of COPD: Is Inhaled Maintenance Therapy Modified?

Abstract

Combinations of drugs with distinct and complementary mechanisms of action may offer improved efficacy in the treatment of chronic obstructive pulmonary disease (COPD). In two 12-week, double-blind, parallel-group studies, patients with COPD were randomized 1:1:1 to once-daily umeclidinium (UMEC; 62.5 μg and 125 μg) or placebo (PBO), added to twice-daily fluticasone propionate/salmeterol (FP/SAL; 250/50 μg). In both studies, the primary efficacy measure was trough forced expiratory volume in 1 second (FEV1) at Day 85. Secondary endpoints were weighted-mean (WM) FEV1 over 0–6 hours post-dose (Day 84) and rescue albuterol use. Health-related quality of life outcomes (St. George's Respiratory Questionnaire [SGRQ] and COPD assessment test [CAT]) were also examined. Safety was assessed throughout. Both UMEC+FP/SAL doses provided statistically significant improvements in trough FEV1 (Day 85: 0.127–0.148 L) versus PBO+FP/SAL. Similarly, both UMEC+FP/SAL doses provided statistically-significant improvements in 0–6 hours post-dose WM FEV1 versus PBO+FP/SAL (Day 84: 0.144–0.165 L). Rescue use over Weeks 1–12 decreased with UMEC+FP/SAL in both studies versus PBO+FP/SAL (Study 1, 0.3 puffs/day [both doses]; Study 2, 0.5 puffs/day [UMEC 125+FP/SAL]). Decreases from baseline in CAT score were generally larger for both doses of UMEC+FP/SAL versus PBO+FP/SAL (except for Day 84 Study 2). In Study 1, no differences in SGRQ score were observed between UMEC+FP/SAL and PBO+FP/SAL; however, in Study 2, statistically significant improvements were observed with UMEC 62.5+FP/SAL (Day 28) and UMEC 125+FP/SAL (Days 28 and 84) versus PBO+FP/SAL. The incidence of on-treatment adverse events across all treatment groups was 37–41% in Study 1 and 36–38% in Study 2. Overall, these data indicate that the combination of UMEC+FP/SAL can provide additional benefits over FP/SAL alone in patients with COPD.

Epidemiology, treatment, disposition and outcome of patients with acute exacerbation of COPD presenting to emergency departments in Australia and South East Asia: An AANZDEM study

“…Data from an United States administrative data set analysis suggest that AECOPD account for approximately 0.8% of ED visits, that 49% of patients were hospitalized after an ED visit for COPD and that average length of stay (LOS) was approximately 4 days . European studies report admission rates of up to 65% . There is minimal detailed data about demographic and clinical features, assessment, treatment and outcome of patients with AECOPD treated in ED of Australasia and South East Asia (SEA).…”

“…1 European studies report admission rates of up to 65%. 2 There is minimal detailed data about demographic and clinical features, assessment, treatment and outcome of patients with AECOPD treated in ED of Australasia and South East Asia (SEA).…”

Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Primer for Emergency Physicians

“…Use of ICS-based treatment regimens should be carefully considered because their long-term use is associated with the risk of side effects, such as pneumonia, osteoporosis, and diabetes, and increased economic burden (132). An observational study involving patients with COPD exacerbations presenting to the ED showed that emergency care did not usually include changes in inhaled maintenance treatment (133). GOLD recommends that maintenance treatment should be tailored to a patient's needs based on individualized assessment of symptoms and future risk of exacerbations (1).…”