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KMID : 0383820160790010022
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Tuberculosis and Respiratory Diseases
2016 Volume.79 No. 1 p.22 ~ p.30
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Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD
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Kim Sae-Ahm
Lee Ji-Hyun
Kim Eun-Kyung
Kim Tae-Hyung
Kim Woo-Jin
Lee Jin-Hwa
Yoon Ho-Il
Baek Seung-Hee
Lee Jae-Seung
Oh Yeon-Mok
Lee Sang-Do
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Abstract
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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.
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KEYWORD
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Pulmonary Disease, Chronic Obstructive
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