Shin Sun Hye, Kim Deog Kyeom, Kim Sang-Heon, Shin Tae Rim, Jung Ki-Suck, Yoo Kwang Ha, Hwang Ki-Eun, Park Hye Yun, Jo Yong Suk
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea.
J Pers Med. 2022 May 31;12(6):916. doi: 10.3390/jpm12060916.
As most clinical trials have been performed in more symptomatic and higher-risk patients, evidence regarding treatment in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A chronic obstructive pulmonary disease (COPD) is limited. We assessed the distribution of inhaler treatment and sought to investigate the association between inhaled corticosteroid (ICS) use and future exacerbation in GOLD group A COPD patients.
Patients with GOLD group A COPD who received maintenance inhalers were identified from a multicentre, prospective cohort in South Korea. Patients were categorized as group A when they had fewer symptoms and did not experience severe exacerbation in the previous year. Development of moderate or severe exacerbation during the 1-year follow-up was analysed according to baseline inhaler treatment.
In 286 patients with GOLD group A COPD, mono-bronchodilator (37.8%), dual-bronchodilator (29.0%), triple therapy (17.5%), and ICS/long-acting beta-2 agonist (15.4%) were used. Compared to patients without ICS-containing inhalers ( 191), those using ICS ( 95) were more dyspnoeic, and more likely to have asthma history, lower lung function, and bronchodilator response. During the 1-year follow-up, moderate or severe exacerbations occurred in 66 of 286 (23.1%) patients. In the multivariable logistic regression analysis, ICS-containing inhaler use was not associated with the development of exacerbation, even in the subgroup with a high probability of asthma-COPD overlap.
Although about one-third of patients with GOLD group A COPD were using ICS-containing inhalers, use of ICS was not associated with a reduction in the future development of exacerbation.
由于大多数临床试验是在症状更明显、风险更高的患者中进行的，关于慢性阻塞性肺疾病全球倡议（GOLD）A组慢性阻塞性肺疾病（COPD）患者治疗的证据有限。我们评估了吸入器治疗的分布情况，并试图研究吸入性糖皮质激素（ICS）的使用与GOLD A组COPD患者未来急性加重之间的关联。
从韩国一项多中心前瞻性队列研究中确定接受维持性吸入器治疗的GOLD A组COPD患者。如果患者症状较少且在前一年未经历严重急性加重，则将其归类为A组。根据基线吸入器治疗情况分析1年随访期间中度或重度急性加重的发生情况。
在286例GOLD A组COPD患者中，使用单支气管扩张剂的占37.8%，双支气管扩张剂的占29.0%，三联疗法的占17.5%，ICS/长效β2受体激动剂的占15.4%。与未使用含ICS吸入器的患者（191例）相比，使用ICS的患者（95例）呼吸困难更严重，更有可能有哮喘病史、肺功能较低和支气管扩张剂反应。在1年的随访期间，286例患者中有66例（23.1%）发生了中度或重度急性加重。在多变量逻辑回归分析中，即使在哮喘-COPD重叠可能性较高的亚组中，使用含ICS吸入器也与急性加重的发生无关。
尽管约三分之一的GOLD A组COPD患者使用含ICS吸入器，但使用ICS与未来急性加重的减少无关。
