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Tuberc Respir Dis (Seoul). 2016 Jan;79(1):22-30. doi: 10.4046/trd.2016.79.1.22. Epub 2015 Dec 31.

Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD.

Author information

1
Department of Internal Medicinem, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
2
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
3
Division of Pulmonology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
4
Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea.
5
Department of Internal Medicine, Ewha Womens University Mokdong Hospital, Ewha Womens University School of Medicine, Seoul, Korea.
6
Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
7
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
8
Department of Pulmonary and Critical Care Medicine, Asthma Center, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUND:

The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting β2-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice.

METHODS:

Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39). The index time was defined as the time of withdrawal in the stepdown group and as 1 year after the start of triple therapy in the triple group.

RESULTS:

Lung function at the index time was superior and the previous exacerbation frequency was lower in the stepdown group than in the triple group. Step-down resulted in aggravating disease symptoms, a reduced overall quality of life, decreasing exercise performance, and accelerated forced expiratory volume in 1 second (FEV1) decline (54.7±15.7 mL/yr vs. 10.7±7.1 mL/yr, p=0.007), but there was no observed increase in the frequency of exacerbations.

CONCLUSION:

Withdrawal of a single inhaler during triple therapy in COPD patients should be conducted with caution as it may impair the exercise capacity and quality of life while accelerating FEV1 decline.

KEYWORDS:

Chronic Obstructive; Pulmonary Disease

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