Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centred outcomes

Abstract

Bronchodilators are central to the management of chronic obstructive pulmonary disease (COPD). Clinical studies combining different classes of bronchodilators, in particular a long-acting muscarinic antagonist (LAMA) and a long-acting β2-agonist (LABA), have demonstrated greater improvements in lung function (forced expiratory volume in 1 second, FEV1) in patients with COPD than monotherapy. FEV1 has served as an important diagnostic measurement of COPD, and the majority of clinical studies of currently available pharmacotherapies grade effectiveness of treatment regimens based on improvements in FEV1. However, FEV1 alone may not adequately reflect the overall health status of the patient. Published evidence suggests that LABA/LAMA combination therapies demonstrate greater improvements in patient-centred outcomes such as dyspnoea, symptoms, rescue medication use, and quality of life than individual drugs used alone. Evaluating patient-centred outcomes associated with COPD is likely to play an important role in future research as a measure of overall treatment effectiveness. Raising awareness of the importance of outcomes beyond lung function alone, particularly in primary care where most patients initially present themselves for medical evaluation, should form a fundamental part of a more holistic approach to COPD management.

Figure 1. Mean IC before (24-hr baseline) and at the end of 2-week treatment periods (means adjusted for period, centre, and patient within centre). ^*p<0.05 tiotropium + formoterol twice daily (bid) vs. tiotropium; ^#p<0.05 tiotropium + formoterol once daily (qd) vs. tiotropium; ^†p<0.05 tiotropium + formoterol twice daily vs. tiotropium + formoterol once daily. IC=inspiratory capacity

Figure 2. Mean number of puffs of rescue medication (salbutamol) per day over (a) 2-week and (b) 6-week treatment periods. NS=not significant, SEM=standard error of mean. *p<0.05 vs. tiotropium