Paradigm Shift in the Treatment of Chronic Obstructive Pulmonary Disease Improves Patient Outcomes.

Purpose: This study evaluates the real-world impact of LAMA+LABA combination therapy on COPD outcomes, bridging the gap between experimental data and clinical practice. It aims to assess whether the paradigm shift in the treatment of chronic obstructive pulmonary disease has improved patient outcomes, particularly in terms of acute exacerbations, hospitalizations, and mortality, while providing insights to guide clinical and policy decisions.

Patients and methods: This retrospective study analyzes cohorts derived from outpatient and inpatient medical records from Taiwan's National Health Insurance Research Database. It includes individuals diagnosed with COPD in two periods: 2012-2014 and 2016-2018.

Results: The paradigm shift in COPD treatment has led to a significant transition in medication selection, moving away from single-agent or supplementary inhaled corticosteroid (ICS) regimens (from 99.61% to 20.99%) towards the use of dual bronchodilators or triple therapy (from 0.38% to 79.02%). The analysis between long-acting muscarinic antagonists (LAMAs) and long-acting beta-agonists (LABAs) revealed no statistically significant differences in emergency department visits and hospitalizations. However, LABAs were associated with a notable reduction in all-cause mortality compared to LAMAs (aHR 0.674-0.765). Additionally, the widespread adoption of dual bronchodilator therapy and the implementation of precise guidelines for ICS use have led to significant reductions in emergency department visits (aHR 0.557-0.735), decreased hospitalizations (aHR 0.610-0.725), and improved mortality outcomes (aHR 0.226-0.294) among COPD patients.

Conclusion: The paradigm shift in treatment approaches has led to substantial improvements in patient outcomes for COPD, regardless of the treatment regimen employed. This development marks a significant advancement in enhancing both the efficacy and precision of COPD management.