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

Authors
Lee, JH; Lee, YK; Kim, EK; Kim, TH; Huh, JW; Kim, WJ; Lee, SM; Lee, S; Lim, SY; Shin, TR; Yoon, HI; Sheen, SS; Kim, N; Seo, JB; Oh, YM; Lee, SD
Citation
Respiratory medicine, 104(4):542-549, 2010
Journal Title
Respiratory medicine
ISSN
0954-61111532-3064
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 FEV(1) more than 45% of the predicted value. The obstruction-dominant subtype had an emphysema index < or = 20% and FEV(1) < or = 45%, the mild-mixed subtype had an emphysema index < or = 20% and FEV(1) > 45%, and the severe-mixed subtype had an emphysema index > 20% and FEV(1) < or = 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 FEV(1) increase and more marked dyspnea improvement than did the emphysema-dominant subgroup. The mixed-subtype patients (both subgroups) also showed significant improvement in FEV(1) compared with the emphysema-dominant subgroup. Emphysema-dominant subtype patients showed no improvement in FEV(1) 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.
MeSH terms
Administration, InhalationAdrenal Cortex Hormones/therapeutic useAgedAnalysis of VarianceBronchodilator Agents/*therapeutic useDrug Administration ScheduleDyspnea/classification/*drug therapy/physiopathologyFemaleForced Expiratory Volume/drug effects/physiologyHumansKoreaMalePatient CompliancePulmonary Disease, Chronic Obstructive/classification/*drugPulmonary Emphysema/classification/*drug therapy/physiopathologyReceptors, Adrenergic, beta-2/*therapeutic useSeverity of Illness IndexSpirometryTreatment Outcome
DOI
10.1016/j.rmed.2009.10.024
PMID
19926461
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Journal Papers > School of Medicine / Graduate School of Medicine > Pulmonary & Critical Care Medicine
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