Clinical outcomes of long-term inhaled combination therapies in patients with bronchiectasis and airflow obstruction
Abstract Background and objectives Few studies have reported which inhaled combination therapy, either bronchodilators and/or inhaled corticosteroids (ICSs), is beneficial in patients with bronchiectasis and airflow obstruction. Our study compared the efficacy and safety among different inhaled comb...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-024-02867-4 |
| _version_ | 1797340382345822208 |
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| author | Hyo Jin Lee Jung-Kyu Lee Tae Yeon Park Eun Young Heo Deog Kyeom Kim Hyun Woo Lee |
| author_facet | Hyo Jin Lee Jung-Kyu Lee Tae Yeon Park Eun Young Heo Deog Kyeom Kim Hyun Woo Lee |
| author_sort | Hyo Jin Lee |
| collection | DOAJ |
| description | Abstract Background and objectives Few studies have reported which inhaled combination therapy, either bronchodilators and/or inhaled corticosteroids (ICSs), is beneficial in patients with bronchiectasis and airflow obstruction. Our study compared the efficacy and safety among different inhaled combination therapies in patients with bronchiectasis and airflow obstruction. Methods Our retrospective study analyzed the patients with forced expiratory volume in 1 s (FEV1)/forced vital capacity < 0.7 and radiologically confirmed bronchiectasis in chest computed tomography between January 2005 and December 2021. The eligible patients underwent baseline and follow-up spirometric assessments. The primary endpoint was the development of a moderate-to-severe exacerbation. The secondary endpoints were the change in the annual FEV1 and the adverse events. Subgroup analyses were performed according to the blood eosinophil count (BEC). Results Among 179 patients, the ICS/long-acting beta-agonist (LABA)/long-acting muscarinic antagonist (LAMA), ICS/LABA, and LABA/LAMA groups were comprised of 58 (32.4%), 52 (29.1%), and 69 (38.5%) patients, respectively. ICS/LABA/LAMA group had a higher severity of bronchiectasis and airflow obstruction, than other groups. In the subgroup with BEC ≥ 300/uL, the risk of moderate-to-severe exacerbation was lower in the ICS/LABA/LAMA group (adjusted HR = 0.137 [95% CI = 0.034–0.553]) and the ICS/LABA group (adjusted HR = 0.196 [95% CI = 0.045–0.861]) compared with the LABA/LAMA group. The annual FEV1 decline rate was significantly worsened in the ICS/LABA group compared to the LABA/LAMA group (adjusted β-coefficient=-197 [95% CI=-307–-87]) in the subgroup with BEC < 200/uL. Conclusion In patients with bronchiectasis and airflow obstruction, the use of ICS/LABA/LAMA and ICS/LABA demonstrated a reduced risk of exacerbation compared to LABA/LAMA therapy in those with BEC ≥ 300/uL. Conversely, for those with BEC < 200/uL, the use of ICS/LABA was associated with an accelerated decline in FEV1 in comparison to LABA/LAMA therapy. Further assessment of BEC is necessary as a potential biomarker for the use of ICS in patients with bronchiectasis and airflow obstruction. |
| first_indexed | 2024-03-08T10:02:18Z |
| format | Article |
| id | doaj.art-ed961ae74dfb4f999b141db01c18adda |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-03-08T10:02:18Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-ed961ae74dfb4f999b141db01c18adda2024-01-29T10:54:49ZengBMCBMC Pulmonary Medicine1471-24662024-01-0124111110.1186/s12890-024-02867-4Clinical outcomes of long-term inhaled combination therapies in patients with bronchiectasis and airflow obstructionHyo Jin Lee0Jung-Kyu Lee1Tae Yeon Park2Eun Young Heo3Deog Kyeom Kim4Hyun Woo Lee5Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical CenterDivision of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical CenterDivision of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical CenterDivision of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical CenterDivision of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical CenterDivision of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical CenterAbstract Background and objectives Few studies have reported which inhaled combination therapy, either bronchodilators and/or inhaled corticosteroids (ICSs), is beneficial in patients with bronchiectasis and airflow obstruction. Our study compared the efficacy and safety among different inhaled combination therapies in patients with bronchiectasis and airflow obstruction. Methods Our retrospective study analyzed the patients with forced expiratory volume in 1 s (FEV1)/forced vital capacity < 0.7 and radiologically confirmed bronchiectasis in chest computed tomography between January 2005 and December 2021. The eligible patients underwent baseline and follow-up spirometric assessments. The primary endpoint was the development of a moderate-to-severe exacerbation. The secondary endpoints were the change in the annual FEV1 and the adverse events. Subgroup analyses were performed according to the blood eosinophil count (BEC). Results Among 179 patients, the ICS/long-acting beta-agonist (LABA)/long-acting muscarinic antagonist (LAMA), ICS/LABA, and LABA/LAMA groups were comprised of 58 (32.4%), 52 (29.1%), and 69 (38.5%) patients, respectively. ICS/LABA/LAMA group had a higher severity of bronchiectasis and airflow obstruction, than other groups. In the subgroup with BEC ≥ 300/uL, the risk of moderate-to-severe exacerbation was lower in the ICS/LABA/LAMA group (adjusted HR = 0.137 [95% CI = 0.034–0.553]) and the ICS/LABA group (adjusted HR = 0.196 [95% CI = 0.045–0.861]) compared with the LABA/LAMA group. The annual FEV1 decline rate was significantly worsened in the ICS/LABA group compared to the LABA/LAMA group (adjusted β-coefficient=-197 [95% CI=-307–-87]) in the subgroup with BEC < 200/uL. Conclusion In patients with bronchiectasis and airflow obstruction, the use of ICS/LABA/LAMA and ICS/LABA demonstrated a reduced risk of exacerbation compared to LABA/LAMA therapy in those with BEC ≥ 300/uL. Conversely, for those with BEC < 200/uL, the use of ICS/LABA was associated with an accelerated decline in FEV1 in comparison to LABA/LAMA therapy. Further assessment of BEC is necessary as a potential biomarker for the use of ICS in patients with bronchiectasis and airflow obstruction.https://doi.org/10.1186/s12890-024-02867-4BronchiectasisCOPDInhaled corticosteroidBronchodilator agentFEV1Exacerbation |
| spellingShingle | Hyo Jin Lee Jung-Kyu Lee Tae Yeon Park Eun Young Heo Deog Kyeom Kim Hyun Woo Lee Clinical outcomes of long-term inhaled combination therapies in patients with bronchiectasis and airflow obstruction BMC Pulmonary Medicine Bronchiectasis COPD Inhaled corticosteroid Bronchodilator agent FEV1 Exacerbation |
| title | Clinical outcomes of long-term inhaled combination therapies in patients with bronchiectasis and airflow obstruction |
| title_full | Clinical outcomes of long-term inhaled combination therapies in patients with bronchiectasis and airflow obstruction |
| title_fullStr | Clinical outcomes of long-term inhaled combination therapies in patients with bronchiectasis and airflow obstruction |
| title_full_unstemmed | Clinical outcomes of long-term inhaled combination therapies in patients with bronchiectasis and airflow obstruction |
| title_short | Clinical outcomes of long-term inhaled combination therapies in patients with bronchiectasis and airflow obstruction |
| title_sort | clinical outcomes of long term inhaled combination therapies in patients with bronchiectasis and airflow obstruction |
| topic | Bronchiectasis COPD Inhaled corticosteroid Bronchodilator agent FEV1 Exacerbation |
| url | https://doi.org/10.1186/s12890-024-02867-4 |
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