COPD: Journal of Chronic Obstructive Pulmonary Disease最新文献

{"title":"It Is Smart to Set Treatment Goals, But Are Set Treatment Goals SMART? A Qualitative Assessment of Goals Described in the Assessment of the Burden of COPD Tool.","authors":"M Voorhaar, O C P van Schayck, B Winkens, J W M Muris, A H M Slok","doi":"10.1080/15412555.2023.2289908","DOIUrl":"10.1080/15412555.2023.2289908","url":null,"abstract":"<p><p>The Assessment of the Burden of COPD (ABC) tool facilitates shared decision-making and goal setting to develop a personalized care plan. In a previous trial (RCT), the ABC tool was found to have a significant effect on patients' Health-related Quality of Life (HRQoL). In this exploratory study we used data from the intervention group of the RCT to investigate if patients with health-related goals had an improved HRQoL compared to those without goals, and if the quality and types of goals differed for those who have a clinically meaningful improvement in HRQoL. We hypothesized that the quality and the type of the goal described in the ABC tool, relates to an improved HRQoL. We assessed the quality of the goals according to the Specificity, Measurability, Achievability, Relevance and Timeliness (SMART) criteria, and coded and counted each type of goal. We found that having a goal or not, did not differ significantly for those who had a clinically meaningful improved HRQoL versus those who had not, nor was the quality or type of goal significantly different. The most common types of goals were exercise more, smoke less, and improve weight. Based on the results, we speculate that when a clinically meaningful improvement in HRQoL is achieved, it is not related to a single component (i.e. goal setting as part of shared decision-making) but that the different components of the ABC tool (visualization of burden, shared decision making, utilization of tailored evidence based interventions, and regular monitoring of progress) may have a synergistic effect on disease cognition and/or behavior change. Noteworthy, the sample size was small while the calculated effect size was moderate, making it unlikely to find a significant effect.</p>","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"20 1","pages":"357-362"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139097518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal-Resource Home Exercise Program Improves Activities of Daily Living, Perceived Health Status, and Shortness of Breath in Individuals with COPD Stages GOLD II to IV.","authors":"Vanessa Joaquim Ribeiro Moço,&nbsp;Aline Almeida Gulart,&nbsp;Agnaldo José Lopes,&nbsp;Arthur de Sá Ferreira,&nbsp;Luis Felipe da Fonseca Reis","doi":"10.1080/15412555.2023.2253907","DOIUrl":"10.1080/15412555.2023.2253907","url":null,"abstract":"<p><p>Home exercises (HE) with minimal resources seem to be useful in individuals with COPD. The objective was to evaluate the effects of HE, on activities of daily living (ADL), dyspnea, on the health status(CAT) and quality of life (HRQoL) of individuals with COPD GOLD II to IV. Quasi-experimental study of the effects of HE, for 2 months, 3 times a week. Individuals with COPD(<i>n</i> = 45) were recruited, 37 started the protocol(9 did not complete it). 28 individuals (mean age 62.04 ± 5.8 years, FEV1: 44.7 ± 2.25%, FEV1/FVC 59.8 ± 6.9%) were evaluated before and after training. We observed improvements in the ADL-Glittre (4.9 ± 1.4 vs 3.9 ± 1.1 min; mean difference: -0.9 ± 0.2 min [95%CI: -1.3 to -0.2]; <i>p</i> = 0.008), as well as the mMRC score(2.8 ± 1.1 vs 2.07 ± 0.81; mean difference: 0.7 ± 0.3 [95%CI: -1.20.18 to -0.2]; <i>p</i> = 0.009), and in the CAT (25.6 ± 4.8 vs 18.9 ± 3.1; mean difference: -6.6 ± 3.4 [95%CI: -10.6 to -1.6]; <i>p</i> = 0.042). Analyzing the mean change before and after the intervention, a weak correlation was observed between ADL-Glittre and mMRC (<i>r</i> = 0.35; [95% CI 0.09; 0.56]; <i>p</i> = 0.009); moderate between ADL-Glittre and CAT (<i>r</i> = 0.52; [95% CI 0.30; 0.69]; <i>p</i> < 0.001) and between ADL-Glittre and SGRQ (<i>r</i> = 0.50; [95% CI 0 .27; 0.67]; <i>p</i> < 0.001). Individuals with COPD can benefit from HE performed autonomously and with minimal resources, as this proposal improves functional capacity for ADL, health perception and dyspnea.</p>","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"20 1","pages":"298-306"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41233046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Composition, Physical Function and Exercise Capacity in Chronic Obstructive Pulmonary Disease.","authors":"Christa M Todoroff, Michael J Berry","doi":"10.1080/15412555.2023.2237583","DOIUrl":"10.1080/15412555.2023.2237583","url":null,"abstract":"<p><p>Current literature yields unequivocal results regarding the effect of body composition on physical function in patients with chronic obstructive pulmonary disease and disproportionately includes a majority of males. The purpose of this study was to determine whether specific body composition measures are significantly associated with physical function and exercise capacity in patients with chronic obstructive pulmonary disease with equal representation of males and females. Independent variables included sex, total body mass, total body lean and fat mass, appendicular total mass, and appendicular lean and fat mass. Dependent variables included peak oxygen consumption, 6-minute walk distance and self-reported physical function. Patients (<i>n</i> = 170) with dual-energy X-ray absorptiometry data, 6-minute walk distance, and self-reported physical function were used for these analyses. A sub-set of 145 of these patients with peak oxygen consumption data were also analysed. Hierarchical multiple regression analysis was used to determine if sex and body composition measures correlated with physical function and exercise capacity and if they explained additional variance after controlling for disease severity. After controlling for disease severity, appendicular lean mass, total body fat mass, and sex explained an additional 16.5% of the variance in peak oxygen consumption (<i>p</i> < 0.001). Appendicular lean mass explained an additional 8.9% of the variance in 6-minute walk distance (<i>p</i> < 0.001) and an additional 2.5% of the variance in self-reported physical function (<i>p</i> = 0.057). Body composition measures may further predict exercise capacity, 6-minute walk distance, and self-reported physical function in patients with chronic obstructive pulmonary disease.</p>","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"20 1","pages":"256-261"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9998997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sevoflurane with Low Concentration Decrease DNA Methylation on Chronic Obstructive Pulmonary Disease (COPD)-Related Gene Promoter in COPD Rat.","authors":"Chuanxin Yang, Libing Deng, Fang Bao, Hui Jiang, Long Zhang","doi":"10.1080/15412555.2023.2278282","DOIUrl":"10.1080/15412555.2023.2278282","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a difficult-to-cure disease that mainly affects the respiratory system. Inhaled anesthetic drug such as sevoflurane plays a controversial role in COPD by different concentration, but the underlying epigenetic mechanism remains unclear. Here, we prepared lipopolysaccharide (LPS)-induced COPD rat model, and isolated Alveolar type II (ATII) cells. We mainly focused DNA methylation on the promoter of COPD-related genes including <i>Sftpa1</i>, <i>Napsa</i>, <i>Ca2</i>, <i>Sfta2</i>, <i>Lamp3</i>, <i>Wif1</i>, <i>Pgc</i>, and <i>Etv5</i>. We observed COPD rat treated by sevoflurane with low (0.5%) and high (2%) concentrations displayed an opposite DNA methylation pattern. These six genes' promoter were all hypomethylated by 0.5% sevoflurane whereas hypermethylated by 2% sevoflurane, accompanied with the opposite transcriptional activity. We further verified that the DNMT1 binding ability contributed to DNA methylation these six genes' promoter. Moreover, we also captured DNMT1 and identified REC8 meiotic recombination protein (REC8) as the specific binding protein only existed in ATII cells treated with 0.5% sevoflurane rather than 2% and control. The binding ability of REC8 on these target genes' promoter showed highly positive correlation with DNMT1. In summary, we uncovered a potential epigenetic role of sevoflurane with low concentration in ATII cells of COPD that may help us deeply understand the pathogenesis and treatment mechanism of inhaled anesthesia drugs in COPD <i>via</i> a dose-dependent manner.</p>","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"20 1","pages":"348-356"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138444202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FOXO3 Activation Prevents Cellular Senescence in Emphysema Induced by Cigarette Smoke.","authors":"Hui Jiang, Yuanrui Xu, Yaona Jiang, Yaqing Li","doi":"10.1080/15412555.2022.2164262","DOIUrl":"10.1080/15412555.2022.2164262","url":null,"abstract":"<p><p>Because cigarette smoke can induce COPD/emphysema through accelerating senescence with or without an incomplete repair system. However, the pathogenesis of COPD following lung senescence induced by CS is not fully understood. Airspace enlargement and airway epithelial cell senescence are common finding during the COPD development. We investigated the lung tress response to CS and demonstrated that a stress-responsive transcription factor, FOXO3, was regulated by deacetylase. SIRT1 inhibited FOXO3 acetylation and FOXO3 degradation, leading to FOXO3 accumulation and activation in airway epithelial cells. CS exposure activated SIRT1 contributed to FOXO3 activation and functioned to protect lungs, as deletion of SIRT1 decreased CS-induced FOXO3 activation and resulted in more severe airway epithelial cells senescence airspace enlargement. Strikingly, deletion of FOXO3 during the development of COPD aggravated lung structural and functional damage, leading to a much more profound COPD phenotype. We show that deletion of FOXO3 resulted in decreased autophagic response and increased senescence, which may explain lung protection by FOXO3. Our study indicates that in the COPD, stress-responsive transcription factors can be activated for adaptions to counteract senescence insults, thus attenuating COPD development.</p>","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":" ","pages":"80-91"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10543394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative Analyses of Mendelian Randomization and Transcriptomic Data Reveal No Association between Leptin and Chronic Obstructive Pulmonary Disease.","authors":"Ao Zhang,&nbsp;Suyan Tian","doi":"10.1080/15412555.2023.2260890","DOIUrl":"10.1080/15412555.2023.2260890","url":null,"abstract":"<p><p>As a key adipokine, leptin has been extensively investigated for its potential role in the pathogenesis of chronic obstructive pulmonary disease (COPD). However, concordant conclusions have not been attained. In this study, we investigated the relationship between leptin and COPD using an integrative analysis that combined a Mendelian randomization (MR) study with transcriptomic data analysis. Here, the MR analysis was performed on the online platform MR-Base, and the bioinformatics analyses were performed with the aid of R Bioconductor packages. No evidence was found by the integrative analysis to support the association of the two attributes. All methods detected a null causal effect of leptin on COPD in the MR analysis. In particular, when the genetically predicted leptin level increased one unit, the risk of developing COPD was estimated as 0.999 (<i>p</i> = 0.943), 0.920 (<i>p</i> = 0.516), 1.002 (<i>p</i> = 0.885), and 1.002 (<i>p</i> = 0.906) by the Inverse Variance Weighted (IVW), MR-Egger, weighted median, and weighted mode method, respectively. Furthermore, no leptin-associated genes except one were identified as being differentially expressed between COPD and control in bioinformatics analysis. The observed association between leptin and COPD in previous observational studies may be attributable to unmeasured confounding effects or reverse causation.</p>","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"20 1","pages":"321-326"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41114783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Communication Tool between Patients and Physicians for Recognizing COPD Exacerbations in Japan.","authors":"Paul Jones, Osamu Hataji, Yoshimi Suzukamo, Bruce Crawford, Yoko Sakai, Takeo Ishii, Keiko Sato, Eri Sasaki, Kenichi Hashimoto, Toru Oga","doi":"10.1080/15412555.2023.2219742","DOIUrl":"10.1080/15412555.2023.2219742","url":null,"abstract":"<p><p>In Japan, exacerbations are underreported compared with other countries, possibly due in part to a failure to recognize them. This study aimed to create a simple chronic obstructive pulmonary disease (COPD) Exacerbation Recognition Tool (CERT-J) specifically for Japanese patients. Patients ≥40 years with confirmed COPD or asthma-COPD overlap were included. Focus groups were held to identify words and phrases used by patients to describe symptoms associated with an exacerbation, resulting in candidate items being identified. Following cognitive debriefing, the items were refined based on item frequency, level of endorsement and effect of demographic factors. Exploratory factor analysis (EFA) was then performed to inform an expert panel's choice of items to form the new tool. A total of 41 patients were included in the focus groups and nine patients performed the cognitive debrief. Following this, the expert panel identified 26 items for testing in a further 100 patients (mean age 72 years, forced expiratory volume in 1 s 54.8% predicted and 1.8 exacerbations in the preceding 12 months). Eleven items were associated with breathlessness or activity limitation and seven of these were the most frequently endorsed. EFA identified four factors, with one (breathlessness) being dominant. The expert panel recommended that the CERT-J should include six items: breathlessness and activity limitation (3 items), cough (1 item) and phlegm (2 items). The final CERT-J should benefit patients with COPD by providing them with an increased understanding and recognition of exacerbations.<b>Clinical Trial Registration:</b> GSK K.K (jRCT1080224526).</p>","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"20 1","pages":"216-223"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9816567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest MRI and CT Predictors of 10-Year All-Cause Mortality in COPD.","authors":"Maksym Sharma,&nbsp;Paulina V Wyszkiewicz,&nbsp;Alexander M Matheson,&nbsp;David G McCormack,&nbsp;Grace Parraga","doi":"10.1080/15412555.2023.2259224","DOIUrl":"https://doi.org/10.1080/15412555.2023.2259224","url":null,"abstract":"<p><p>Pulmonary imaging measurements using magnetic resonance imaging (MRI) and computed tomography (CT) have the potential to deepen our understanding of chronic obstructive pulmonary disease (COPD) by measuring airway and parenchymal pathologic information that cannot be provided by spirometry. Currently, MRI and CT measurements are not included in mortality risk predictions, diagnosis, or COPD staging. We evaluated baseline pulmonary function, MRI and CT measurements alongside imaging texture-features to predict 10-year all-cause mortality in ex-smokers with (<i>n</i> = 93; 31 females; 70 ± 9years) and without (<i>n</i> = 69; 29 females, 69 ± 9years) COPD. CT airway and vessel measurements, helium-3 (³He) MRI ventilation defect percent (VDP) and apparent diffusion coefficients (ADC) were quantified. MRI and CT texture-features were extracted using PyRadiomics (version2.2.0). Associations between 10-year all-cause mortality and all clinical and imaging measurements were evaluated using multivariable regression model odds-ratios. Machine-learning predictive models for 10-year all-cause mortality were evaluated using area-under-receiver-operator-characteristic-curve (AUC), sensitivity and specificity analyses. DL_CO (%_pred) (HR = 0.955, 95%CI: 0.934-0.976, <i>p</i> < 0.001), MRI ADC (HR = 1.843, 95%CI: 1.260-2.871, <i>p</i> < 0.001), and CT informational-measure-of-correlation (HR = 3.546, 95% CI: 1.660-7.573, <i>p</i> = 0.001) were the strongest predictors of 10-year mortality. A machine-learning model trained on clinical, imaging, and imaging textures was the best predictive model (AUC = 0.82, sensitivity = 83%, specificity = 84%) and outperformed the solely clinical model (AUC = 0.76, sensitivity = 77%, specificity = 79%). In ex-smokers, regardless of COPD status, addition of CT and MR imaging texture measurements to clinical models provided unique prognostic information of mortality risk that can allow for better clinical management.<b>Clinical Trial Registration:</b> www.clinicaltrials.gov NCT02279329.</p>","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"20 1","pages":"307-320"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41194095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of Prediction Models for Exacerbation, Frequent Exacerbations and Severe Exacerbations of Chronic Obstructive Pulmonary Disease: A Registry Study in North China.","authors":"Yuyan Zhou,&nbsp;Siqi He,&nbsp;Wanying Wang,&nbsp;Xiaoyue Wang,&nbsp;Xiaoting Chen,&nbsp;Xiaoning Bu,&nbsp;Deshuai Li","doi":"10.1080/15412555.2023.2263562","DOIUrl":"10.1080/15412555.2023.2263562","url":null,"abstract":"<p><p>In COPD patients, exacerbation has a detrimental influence on the quality of life, disease progression and socioeconomic burden. This study aimed to develop and validate models to predict exacerbation, frequent exacerbations and severe exacerbations in COPD patients. We conducted an observational prospective multicenter study. Clinical data of all outpatients with stable COPD were collected from Beijing Chaoyang Hospital and Beijing Renhe Hospital between January 2018 and December 2019. Patients were followed up for 1 year. The data from Chaoyang Hospital was used for modeling dataset, and that of Renhe Hospital was used for external validation dataset. The final dataset included 456 patients, with 326 patients as the model group and 130 patients as the validation group. Using LABA + ICS, frequent exacerbations in the past year and CAT score were independent risk factors for exacerbation in the next year (OR = 2.307, 2.722 and 1.147), and FVC %pred as a protective factor (OR = 0.975). Combined with chronic heart failure, frequent exacerbations in the past year, blood EOS counts and CAT score were independent risk factors for frequent exacerbations in the next year (OR = 4.818, 2.602, 1.015 and 1.342). Using LABA + ICS, combined with chronic heart failure, frequent exacerbations in the past year and CAT score were independent risk factors for severe exacerbations in the next year (OR = 1.950, 3.135, 2.980 and 1.133). Based on these prognostic models, nomograms were generated. The prediction models were simple and useful tools for predicting the risk of exacerbation, frequent exacerbations and severe exacerbations of COPD patients in North China.</p>","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"20 1","pages":"327-337"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49689116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triple Inhaler versus Dual Bronchodilator Therapy in COPD: Real-World Effectiveness on Mortality.","authors":"Samy Suissa,&nbsp;Sophie Dell'Aniello,&nbsp;Pierre Ernst","doi":"10.1080/15412555.2021.1977789","DOIUrl":"https://doi.org/10.1080/15412555.2021.1977789","url":null,"abstract":"<p><p>Randomized trials of triple therapy including an inhaled corticosteroid (ICS) for chronic obstructive pulmonary disease (COPD) reported remarkable benefits on mortality compared with dual bronchodilators, likely resulting from ICS withdrawal at randomization. We compared triple therapy with dual bronchodilator combinations on major COPD outcomes in a real-world clinical practice setting. We identified a cohort of COPD patients, age 50 or older, treated during 2002-2018, from the United Kingdom's Clinical Practice Research Datalink. Patients initiating treatment with a long-acting muscarinic antagonist (LAMA), a long-acting beta₂-agonist (LABA) and an ICS on the same day, were compared with patients initiating a LAMA and LABA, weighted by fine stratification of propensity scores. Subjects were followed-up one year for all-cause mortality, severe exacerbation and pneumonia. The cohort included 117,729 new-users of LAMA-LABA-ICS and 26,666 of LAMA-LABA. The adjusted hazard ratio (HR) of all-cause mortality with LAMA-LABA-ICS compared with LAMA-LABA was 1.17 (95% CI: 1.04-1.31) while for severe exacerbation and pneumonia it was 1.19 (1.08-1.32) and 1.29 (1.16-1.45) respectively. However, mortality was not elevated with triple therapy among patients with asthma diagnosis (HR 0.99; 95% CI: 0.74-1.34), with two or more prior exacerbations (HR 0.88; 95% CI: 0.70-1.11), and with FEV₁ percent predicted >30%. In a real-world setting of COPD treatment, triple therapy initiation was not more effective than dual bronchodilators at preventing all-cause mortality and severe COPD exacerbations. Triple therapy may be unsafe among patients without prior exacerbations, in whom ICS are not recommended, with no asthma diagnosis and with very severe airflow obstruction.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1977789 .</p>","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39434054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}