Article (Scientific journals)
Intensified therapy with inhaled corticosteroids and long-acting b2-agonists at the onset of upper respiratory tract infection to prevent chronic obstructive pulmonary disease exacerbations a multicenter, randomized, double-blind, placebo-controlled trial
Stolz, D.; Hirsch, H. H.; Schilter, D. et al.
2018In American Journal of Respiratory and Critical Care Medicine, 197 (9), p. 1136-1146
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Keywords :
ICS; LABA; Treatment for COPD exacerbations; Article; Rhinovirus
Abstract :
[en] Rationale: The efficacy of intensified combination therapy with inhaled corticosteroids (ICS) and long-acting b2-agonists (LABA) at the onset of upper respiratory tract infection (URTI) symptoms in chronic obstructive pulmonary disease (COPD) is unknown. Objectives: To evaluate whether intensified combination therapy with ICS/LABA, at the onset of URTI symptoms, decreases the incidence of COPD exacerbation occurring within 21 days of the URTI. Methods: A total of 450 patients with stable, moderate to very severe COPD, were included in this investigator-initiated and -driven, double-blind, randomized, placebo-controlled study. At inclusion, patients were assigned to open-labeled low-maintenance dose ICS/LABA. Each patient was randomized either to intensified-dose ICS/LABA or placebo and instructed to start using this medication only in case of a URTI, at the onset of symptoms, twice daily, for 10 days. Measurements and Main Results: The incidence of any exacerbation following a URTI was not significantly decreased in the ICS/LABA group, as compared with placebo (14.6% vs. 16.2%; hazard ratio, 0.77; 95% confidence interval, 0.46–1.33; P = 0.321) but the risk of severe exacerbation was decreased by 72% (hazard ratio, 0.28; 95% confidence interval, 0.11–0.74%; P = 0.010). In the stratified analysis, effect size was modified by disease severity, fractional exhaled nitric oxide, and the body mass index–airflow obstruction–dyspnea, and exercise score. Compared with the stable period, evidence of at least one virus was significantly more common at URTI, 10 days after URTI, and at exacerbation. Conclusions: Intensified combination therapy with ICS/LABA for 10 days at URTI onset did not decrease the incidence of any COPD exacerbation but prevented severe exacerbation. Patients with more severe disease had a significant risk reduction for any exacerbation. Copyright © 2018 by the American Thoracic Society.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Stolz, D.;  Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, Basel, Switzerland, Department of Biomedicine, University of Basel, Basel, Switzerland, University of Basel, Basel, Switzerland
Hirsch, H. H.;  Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland, Department of Biomedicine, University of Basel, Basel, Switzerland, University of Basel, Basel, Switzerland, Transplantation and Clinical Virology, Department of Biomedicine, Basel, Switzerland
Schilter, D.;  Lindenhof Hospital, Bern, Switzerland
Louis, Renaud ;  Université de Liège - ULiège > Département des sciences cliniques > Pneumologie - Allergologie
Rakic, Janko
Boeck, L.;  Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, Basel, Switzerland, Department of Biomedicine, University of Basel, Basel, Switzerland, University of Basel, Basel, Switzerland
Papakonstantinou, E.;  Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, Basel, Switzerland, Department of Biomedicine, University of Basel, Basel, Switzerland, University of Basel, Basel, Switzerland
Schindler, C.;  University of Basel, Basel, Switzerland, Swiss Tropical and Public Health Institute, Basel, Switzerland
Grize, L.;  University of Basel, Basel, Switzerland, Swiss Tropical and Public Health Institute, Basel, Switzerland
Tamm, M.;  Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, Basel, Switzerland, Department of Biomedicine, University of Basel, Basel, Switzerland, University of Basel, Basel, Switzerland
Language :
English
Title :
Intensified therapy with inhaled corticosteroids and long-acting b2-agonists at the onset of upper respiratory tract infection to prevent chronic obstructive pulmonary disease exacerbations a multicenter, randomized, double-blind, placebo-controlled trial
Publication date :
May 2018
Journal title :
American Journal of Respiratory and Critical Care Medicine
ISSN :
1073-449X
eISSN :
1535-4970
Publisher :
American Thoracic Society
Volume :
197
Issue :
9
Pages :
1136-1146
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 12 October 2019

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