Responses to inhaled long-acting beta-agonist and corticosteroid according to COPD subtype

Ji Hyun Lee, Young Kyung Lee, Eun Kyung Kim, Tae Hyung Kim, Jin Won Huh, Woo Jin Kim, Jin Hwa Lee, Sang Min Lee, Sangyeub Lee, Seong Yong Lim, Tae Rim Shin, Ho Il Yoon, Seung Soo Sheen, Nam Kug Kim, Joon Beom Seo, Yeon Mok Oh, Sang Do Lee

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77 Citations (Scopus)

Abstract

Rationale: Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disorder in which a number of different pathological processes lead to recognition of patient subgroups that may have individual characteristics and distinct responses to treatment. Objectives: We tested the hypothesis that responses of lung function to 3 months of combined inhalation of long-acting beta-agonist and corticosteroid might differ among patients with various COPD subtypes. Methods: We classified 165 COPD patients into four subtypes according to the severity of emphysema and airflow obstruction: emphysema-dominant, obstruction-dominant, mild-mixed, and severe-mixed. The emphysema-dominant subtype was defined by an emphysema index on computed tomography of more than 20% and FEV1 more than 45% of the predicted value. The obstruction-dominant subtype had an emphysema index ≤ 20% and FEV1 ≤ 45%, the mild-mixed subtype had an emphysema index ≤ 20% and FEV1 > 45%, and the severe-mixed subtype had an emphysema index > 20% and FEV1 ≤ 45%. Patients were recruited prospectively and treated with 3 months of combined inhalation of long-acting beta-agonist and corticosteroid. Results: After 3 months of combined inhalation of long-acting beta-agonist and corticosteroid, obstruction-dominant subtype patients showed a greater FEV1 increase and more marked dyspnea improvement than did the emphysema-dominant subgroup. The mixed-subtype patients (both subgroups) also showed significant improvement in FEV1 compared with the emphysema-dominant subgroup. Emphysema-dominant subtype patients showed no improvement in FEV1 or dyspnea after the 3-month treatment period. Conclusion: The responses to 3 months of combined inhalation of long-acting beta-agonist and corticosteroid differed according to COPD subtype.

Original languageEnglish
Pages (from-to)542-549
Number of pages8
JournalRespiratory Medicine
Volume104
Issue number4
DOIs
Publication statusPublished - 2010 Apr 1

Keywords

  • COPD
  • Corticosteroid
  • Inhaled long acting bronchodilator
  • Subtype

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Lee, J. H., Lee, Y. K., Kim, E. K., Kim, T. H., Huh, J. W., Kim, W. J., Lee, J. H., Lee, S. M., Lee, S., Lim, S. Y., Shin, T. R., Yoon, H. I., Sheen, S. S., Kim, N. K., Seo, J. B., Oh, Y. M., & Lee, S. D. (2010). Responses to inhaled long-acting beta-agonist and corticosteroid according to COPD subtype. Respiratory Medicine, 104(4), 542-549. https://doi.org/10.1016/j.rmed.2009.10.024