Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD

  • Kim, Sae Ahm (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Lee, Ji-Hyun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Kim, Eun-Kyung (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Kim, Tae-Hyung (Division of Pulmonology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Kim, Woo Jin (Department of Internal Medicine, Kangwon National University College of Medicine) ;
  • Lee, Jin Hwa (Department of Internal Medicine, Ewha Womens University Mokdong Hospital, Ewha Womens University School of Medicine) ;
  • Yoon, Ho Il (Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Baek, Seunghee (Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae Seung (Department of Pulmonary and Critical Care Medicine, Asthma Center, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Yeon-Mok (Department of Pulmonary and Critical Care Medicine, Asthma Center, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang-Do (Department of Pulmonary and Critical Care Medicine, Asthma Center, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2015.10.01
  • Accepted : 2015.10.19
  • Published : 2016.01.31
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Abstract

Background: The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting ${\beta}2$-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice. Methods: Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39). The index time was defined as the time of withdrawal in the step-down group and as 1 year after the start of triple therapy in the triple group. Results: Lung function at the index time was superior and the previous exacerbation frequency was lower in the step-down group than in the triple group. Step-down resulted in aggravating disease symptoms, a reduced overall quality of life, decreasing exercise performance, and accelerated forced expiratory volume in 1 second ($FEV_1$) decline ($54.7{\pm}15.7mL/yr$ vs. $10.7{\pm}7.1mL/yr$, p=0.007), but there was no observed increase in the frequency of exacerbations. Conclusion: Withdrawal of a single inhaler during triple therapy in COPD patients should be conducted with caution as it may impair the exercise capacity and quality of life while accelerating $FEV_1$ decline.

Keywords

References

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