The role of long-acting muscarinic antagonist/long-acting β agonist fixed-dose combination treatment for chronic obstructive pulmonary disease in China: a narrative review

Zhou, Jian; Zhang, Jing; Min, Zhou; Hang, Jingqing; Zhang, Min; Han, Fengfeng; Zhu, Huili

doi:10.21037/jtd-21-961

Cited by 3 publications

(4 citation statements)

References 55 publications

(54 reference statements)

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“…1 In line with findings from Zeng et al , 13 LABA + LAMA use throughout the REAL study was consistently low (⩽1.7% regardless of disease severity), although it is worth noting that fixed-dose combination LABA/LAMA therapy was not available in China at the time of the study (LABA/LAMA therapy was included in the medical insurance catalogue in China at the end of 2019). 21 LABA/LAMA therapy has been shown to improve lung function and reduce exacerbation rates without an increase in adverse effects, 21 , 22 but among patients with severe stable COPD treated with fixed-dose combination LABA/LAMA therapy, correct use was only reported in approximately 60%. 23 In the REAL study, ICS/LABA + LAMA use was higher in patients with more severe disease, although not when disease severity was categorized according to GOLD 2017.…”

Section: Discussionmentioning

confidence: 99%

“…First, dual bronchodilation and triple therapy (which are recommended by the GOLD guidelines for the treatment of COPD) were not included in the medical insurance catalogue in China until recent years. 21 Second, tertiary hospitals are less accessible to patients living in rural areas in China. These patients tend to seek treatment at secondary hospitals, which should have the necessary skills and resources to treat COPD exacerbations.…”

Section: Discussionmentioning

confidence: 99%

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Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Yang

Cai

Cao

et al. 2023

Ther Adv Respir Dis

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Background: Underdiagnosis and undertreatment pose major barriers to optimal management of chronic obstructive pulmonary disease (COPD) in China. Objective: The REAL trial was performed to generate reliable information on real-world COPD management, outcomes and risk factors among Chinese patients. Here, we present study outcomes related to COPD management. Design: It is a 52-week, prospective, observational, multicentre study. Methods: Outpatients (aged ⩾40 years) enrolled from 50 secondary and tertiary hospitals across six geographic regions of China were followed up for 12 months, with two onsite visits and by telephone every 3 months following baseline. Results: Between June 2017 and January 2019, 5013 patients were enrolled and 4978 included in the analysis. Mean [standard deviation (SD)] age was 66.2 (8.9) years, the majority of patients were male (79.5%) and mean (SD) time since COPD diagnosis was 3.8 (6.2) years. The most common treatments at each study visit were inhaled corticosteroids/long-acting beta-agonists (ICSs/LABAs; 28.3–36.0%), long-acting muscarinic antagonists (LAMAs; 13.0–16.2%) and ICS/LABA + LAMA (17.5–18.7%), but up to 15.8% of patients at each visit received neither ICS nor long-acting bronchodilators. The use of ICS/LABA, LAMA and ICS/LABA + LAMA differed across regions and hospital tiers; up to fivefold, more patients received neither ICS nor long-acting bronchodilators in secondary (17.3–25.4%) versus tertiary hospitals (5.0–5.3%). Overall, rates of nonpharmacological management were low. Direct treatment costs increased with disease severity, but the proportion of direct treatment costs incurred due to maintenance treatment decreased with disease severity. Conclusion: ICS/LABA, LAMA and ICS/LABA + LAMA were the most frequently prescribed maintenance treatments for patients with stable COPD in China, although their use differed between region and hospital tier. There is a clear need for improved COPD management across China, particularly in secondary hospitals. Registration: The trial was registered on 20 March 2017 (ClinicalTrials.gov identifier: NCT03131362; https://clinicaltrials.gov/ct2/show/NCT03131362 ). Plain language summary Treatment patterns in patients with COPD in China Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by progressive and irreversible airflow limitation. In China, many patients with this disease do not receive a diagnosis or appropriate treatment. Objective: This study aimed to generate reliable information on the treatment patterns among patients with COPD in China to help inform future management strategies. Study design and methods: Patients (aged ⩾40 years) were enrolled from 50 hospitals across 6 regions of China and physicians collected data over the course of 1 year during routine outpatient visits. Results: The majority of patients were receiving long-acting inhaled treatments, which are recommended to prevent worsening of the disease. Up to 16% of patients in this study, however, did not receive any of these recommended treatments. The proportion of patients who received long-acting inhaled treatments differed across regions and hospital tiers; there were about five times more patients in secondary hospitals (about 25%) who did not receive these treatments compared with those in tertiary hospitals (about 5%). Guidelines recommend that pharmacological treatment should be complemented by nondrug treatment, but this was only received by a minority of patients in this study. Patients with higher disease severity incurred greater direct treatment costs compared with those with milder disease. Maintenance treatment costs made up a smaller proportion of overall direct costs for patients with higher disease severity (60–76%) compared with patients with milder disease (81–94%). Conclusion: Long-acting inhaled treatments were the most frequently prescribed maintenance treatments among patients with COPD in China, but their use differed between region and hospital tier. There is a clear need to improve disease management across China, especially in secondary hospitals.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Yang

Cai

Cao

et al. 2023

Ther Adv Respir Dis

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“…Esta estratégia é consistente com as conclusões de alguns estudos encontrados (Di Marco et al, 2018;Ibrahim et al, 2021), que destacam a importância do LAMA como terapia de primeira linha e de manutenção. Apesar disso, a maioria dos estudos sugere a combinação de LAMA/LABA (Calzetta et al, 2017;Stringer et al, 2021;Zhou et al, 2021;Nici et al, 2020).…”

Section: Discussionunclassified

Muscarinic antagonists, respiratory rehabilitation and exercise tolerance in COPD: a narrative review

Bernardes¹,

Santos-Costa²,

Paiva-Santos³

et al. 2023

RevSALUS

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Background: Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable lung inflammatory disease in which professionals can provide patients and caregivers with a specific treatment plan consisting of pharmacological and/or exercise therapy. COPD patients usually control exacerbations and maintain functional status through muscarinic antagonists, either long-acting (LAMA) or short-acting (SABA). One of the functional outcomes of a successful treatment is exercise tolerance, also called subjectively perceived effort during exercise, which is the target of Respiratory Rehabilitation provided by Rehabilitation Nurses. The relationship between pharmacological and nursing interventions in COPD is extremely important for the effectiveness of treatments. It is important to understand how they are associated, when they are used and what results can be obtained in disease management. Aim: Synthesize the relationship between rehabilitation nursing interventions and LAMA/SABA use in COPD management. Materials and Methods: Narrative review in MEDLINE, CINAHL and Cochrane databases, in which, through the screening process, a total of 15 studies were selected. Whittemore and Knafl’s method was used. Results and Conclusions: LAMA and LABA should be used in combination, but efficacy on exercise tolerance levels reduces if there’s no respiratory rehabilitation associated. Nurses should provide counseling and patient education to promote therapy adherence and motivate exercise therapy throughout treatment.

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“… 4 In China, an overall morbidity of COPD is about 8.2%, suggesting an emergent need for prevention and treatment. 5 …”

Section: Introductionmentioning

confidence: 99%

A Novel Metabolic Score for Predicting the Acute Exacerbation in Patients with Chronic Obstructive Pulmonary Disease

Peng¹,

You²,

Xu³

et al. 2023

COPD

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Background Chronic obstructive pulmonary disease (COPD) has higher mortality when developing to acute exacerbation (AECOPD); hence, the early intervention of COPD is critical for preventing AECOPD. Exploring the serum metabolites associated with acute exacerbation in patients with COPD will contribute to the early intervention of COPD. Methods In the study, a non-targeted metabolomics strategy combined with multivariate statistical methods was performed to explore the metabolic profiling of COPD developing acute exacerbation, to screen the potential metabolites associated with AECOPD and to analyze the potential value of these metabolites in predicting the development of COPD. Results Serum lysine, glutamine, 3-hydroxybutyrate, pyruvate and glutamate levels were significantly higher, while 1-methylhistidine, isoleucine, choline, valine, alanine, histidine and leucine levels were significantly lower in AECOPD patients, compared with stable COPD patients after normalization based on the healthy controls. Moreover, eight metabolic pathways were significantly altered (P<0.05) in the serum of AECOPD patients compared with the stable COPD population, including purine metabolism, glutamine and glutamate metabolism, arginine biosynthesis, butyrate metabolism, ketone body synthesis and degradation, and linoleic acid metabolism. In addition, the correlation analysis between metabolites and AECOPD patients demonstrated that an M-score based on a weighted sum of concentrations of four metabolites including pyruvate, isoleucine, 1-methylhistidine and glutamine were significantly associated with the acute exacerbation of pulmonary ventilation function in COPD patients. Conclusion Altogether, the metabolite score based on a weighted sum of concentrations of four serum metabolites was associated with an increased risk of COPD developing acute exacerbation, which will provide a new insight for the understanding of COPD development.

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The role of long-acting muscarinic antagonist/long-acting β agonist fixed-dose combination treatment for chronic obstructive pulmonary disease in China: a narrative review

Cited by 3 publications

References 55 publications

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)

Muscarinic antagonists, respiratory rehabilitation and exercise tolerance in COPD: a narrative review

A Novel Metabolic Score for Predicting the Acute Exacerbation in Patients with Chronic Obstructive Pulmonary Disease

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