Abstract:
RATIONALE:Symptom relief is a key treatment goal in patients with chronic obstructive pulmonary disease (COPD). However, there are limited data available on the response to bronchodilator therapy in patients at low risk of exacerbations with different levels of symptom severity. This study compared treatment responses in patients with a range of symptom severities as indicated by baseline COPD assessment test (CAT) scores. METHODS:The 24-week EMAX trial evaluated the benefits of umeclidinium/vilanterol versus umeclidinium or salmeterol in symptomatic patients at low exacerbation risk who were not receiving inhaled corticosteroids. This analysis assessed lung function, symptoms, health status, and short-term deterioration outcomes in subgroups defined by a baseline CAT score [<20 (post hoc) and ⩾20 (pre-specified)]. Outcomes were also assessed using post hoc fractional polynomial modelling with continuous transformations of baseline CAT score covariates. RESULTS:Of the intent-to-treat population (n = 2425), 56% and 44% had baseline CAT scores of <20 and ⩾20, respectively. Umeclidinium/vilanterol demonstrated favourable improvements compared with umeclidinium and salmeterol for the majority of outcomes irrespective of the baseline CAT score, with the greatest improvements generally observed in patients with CAT scores <20. Fractional polynomial analyses revealed consistent improvements in lung function, symptoms and reduction in rescue medication use with umeclidinium/vilanterol versus umeclidinium and salmeterol across a range of CAT scores, with the largest benefits seen in patients with CAT scores of approximately 10-21. CONCLUSIONS:Patients with symptomatic COPD benefit similarly from dual bronchodilator treatment with umeclidinium/vilanterol. Fractional polynomial analyses demonstrated the greatest treatment differences favouring dual therapy in patients with a CAT score <20, although benefits were seen up to scores of 30. This suggests that dual bronchodilation may be considered as initial therapy for patients across a broad range of symptom severities, not only those with severe symptoms (CAT ⩾20).Trial registration: NCT03034915, 2016-002513-22 (EudraCT number).The reviews of this paper are available via the supplemental material section.
journal_name
Ther Adv Respir Disjournal_title
Therapeutic advances in respiratory diseaseauthors
Vogelmeier CF,Kerwin EM,Bjermer LH,Tombs L,Jones PW,Boucot IH,Naya IP,Lipson DA,Compton C,Barnes N,Maltais Fdoi
10.1177/1753466620968500subject
Has Abstractpub_date
2020-01-01 00:00:00pages
1753466620968500eissn
1753-4658issn
1753-4666journal_volume
14pub_type
杂志文章abstract::The use of biomarkers on pleural fluid (PF) specimens may assist the decision-making process and enhance clinical diagnostic pathways. Three paradigmatic examples are heart failure, tuberculosis and, particularly, malignancy. An elevated PF concentration of the amino-terminal fragment of probrain natriuretic peptide (...
journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,评审
doi:10.1177/1753466618808660
更新日期:2018-01-01 00:00:00
abstract::Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that can present different extrarticular manifestations involving heart, lungs and kidneys. In recent years there has been a growing awareness of the central role played by the lungs in the onset and progression of RA. In particular interstitial lung dise...
journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,评审
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abstract:OBJECTIVES:This study evaluated the effectiveness of behavioral interventions (brief counseling, nonspecific psychological support in groups - NSGS and cognitive behavioral group therapy - CBGT) in combination with bupropion SR for smoking cessation in the field, through a smoking cessation clinic. METHODS:Two-hundred...
journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,随机对照试验
doi:10.1177/1753465809350653
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abstract:BACKGROUND:Proper adjustment of arterial oxygen saturation (SaO2) during daily activities in patients with interstitial lung disease (ILD) requiring long-term oxygen therapy is challenging. Given the multifactorial nature of the limited exercise tolerance in patients with ILDs, the isolated use of oxygen therapy may no...
journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章
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abstract:OBJECTIVE:Severe exacerbations in alpha-1-antitrypsin (AAT)-deficient patients with chronic obstructive pulmonary disease (COPD) and/or emphysema are a major cause of hospitalization. A multicentre, observational, retrospective study was undertaken to evaluate the effect of continuous AAT augmentation therapy in reduci...
journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,多中心研究
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abstract::Allergen-specific immunotherapy remains the most likely effective treatment modality for allergic disorders by targeting the underlying immune mechanisms and possibly causing modifications in the disease course, as well as treating the symptoms. Treatment and compliance experiences been gained over nearly a century in...
journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,评审
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abstract::One of the great challenges of lung transplantation is to bridge the dichotomy between supply and demand of donor organs so that the maximum number of potential recipients achieve a meaningful benefit in improvements in survival and quality of life. To achieve this laudable goal is predicated on choosing candidates wh...
journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,评审
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abstract:OBJECTIVES:Both autofluorescence imaging bronchoscopy and narrow-band imaging have shown promise in the detection of premalignant airway lesions, each by utilizing different bandwidths of lights for better characterization of the mucosal and submucosal vascular grid. Since previously published meta-analyses have shown ...
journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,meta分析
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journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章
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journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,评审
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
doi:10.1177/1753465817708950
更新日期:2017-07-01 00:00:00
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journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,评审
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pub_type: 杂志文章,评审
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pub_type: 杂志文章,多中心研究
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journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,多中心研究,随机对照试验
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journal_title:Therapeutic advances in respiratory disease
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更新日期:2008-04-01 00:00:00
abstract:UNLABELLED:Alpha-1-antitrypsin deficiency [AATD] is associated with variable development of emphysema and other features of chronic obstructive pulmonary disease [COPD]. Matrix metalloproteinases [MMPs] are believed to be important in the pathophysiology of COPD, and may therefore confer susceptibility to this phenotyp...
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更新日期:2009-02-01 00:00:00
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journal_title:Therapeutic advances in respiratory disease
pub_type: 杂志文章,评审
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更新日期:2011-02-01 00:00:00
abstract:OBJECTIVE:To identify potential predictors for invasive and non-invasive mechanical ventilation in coronavirus disease 2019 (COVID-19) patients. METHODS:This study retrospectively analyzes data of 516 patients with confirmed COVID-19, who were categorized into three groups based on which mechanical ventilation method ...
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更新日期:2020-01-01 00:00:00