Management of chronic obstructive pulmonary disease patients quitting smoking: optimization the basic therapy

The aim of this study was to investigate effects of stepping down the dose of inhaled steroid (ICS) or ICS withdrawal in patients with chronic obstructive pulmonary disease (COPD) treated with an adequate bronchodilating therapy and quitting smoking. Methods. The study was performed in real clinical settings. Patients with COPD (n = 41) involved in educational smoking cessation program were followed for 9 months in outpatient settings. Smoking cessation program included varenicline, adequate physical activity, nutritional counseling and bronchodilating therapy; one of the aims of the treatment was ICS dose reduction or complete withdrawal of ICS. Results. Long-acting beta-2-agonist (LABA) indacaterol and dual bronchodilators (indacaterol/glycopyrronium or indacaterol/tiotropium) were effective in patients with COPD quitting tobacco smoking. ICS dose was reduced more quickly in patients treated with indacaterol or dual bronchodilators compared to those treated with formoterol. Quitting smoking was associated with improvement in CAT score and reduction in COPD exacerbation rate. Conclusion. Treatment with indacaterol or indacaterol/glycopyrronium combination was associated with more rapid and safe stepping down the dose of ICS or ICS withdrawal in COPD patients quitting tobacco smoking compared to those treated with formoterol.

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Pocket Guide to COPD Diagnosis, Management, and Prevention. A Guide for Health Care Professionals. 2019 Report. Global Initiative for Chronic Obstructive Lung Disease, Inc.; 2019. Available at: www.goldcopd.org/ [Accessed January 25, 2019].

2. World Health Organization. Global Health Observatory (GHO) data. Available at: http://www.who.int/gho/countries/rus/country_profiles/en/ [Accessed January 25, 2019].

3. Gambaryan M.G. [Chronic respiratory disease and tobacco consumption]. Meditsinskiy sovet. 2016; 17: 144–152. DOI: 10.21518/2079-701X-2016-17-144-152 (in Russian).

4. Juusela M., Pallasaho P., Ronmark E. et al. Dose-dependent association of smoking and bronchial hyperresponsiveness. Eur. Respir. J. 2013; 42 (6): 1503–1512. DOI: 10.1183/09031936.00073712.

5. Chuchalin A.G., Sakharova G.M., Antonov N.S. [Nicotine dependence and nicotine withdrawal syndrome in adults. Clinical guidelines]. Narkologiya. 2018; 17 (3): 3–21 (in Russian).

6. Chuchalin A.G., Antonov N.S., Sakharova G.M., Andreyeva S.A. [Bronchial hyperreactivity in smokers and treatment with Foradyl after quitting smoking]. Pul’monologiya. 2006; (5): 49–55 (in Russian).

7. Aisanov Z.R., Avdeev S.N., Arkhipov V.V. et al. [National Guidelines on Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease” an Algorithm for Making a Clinical Decision]. Pul’monologiya. 2017; 27 (1): 13–20. DOI: 10.18093/0869-0189-2017-27-1-13-20 (in Russian).

8. Vizel’ A.A. [Indacaterol is a novel 24-h acting bronchodilator for treatment of COPD] Atmosfera. Pul’monologiya i allergologiya. 2011; 4: 65–71 (in Russian).

9. Moen M.D. Indacaterol in chronic obstructive pulmonary disease. Drugs. 2010; 70 (17): 2269–2280. DOI: 10.2165/11203960-000000000-00000.

10. Donohue J.F., Betts K.A., Du E.X. et al. Comparative efficacy of long-acting β2-agonists as monotherapy for chronic obstructive pulmonary disease: a network meta-analysis. Int. J. Chron. Obstruct. Pulmon. Dis. 2017; 12: 367–381. DOI: 10.2147/COPD.S119908.

11. Tashkin D.P., Strange C. Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy? Int. J. Chron. Obstruct. Pulmon. Dis. 2018; 13: 2587–2601. DOI: 10.2147/COPD.S172240.

12. Belevskiy A.S., Aisanov Z.R. [Safe withdrawal of inhaled corticosteroids in patients with chronic obstructive pulmonary disease]. Prakticheskaya pul’monologiya. 2018; 1: 98–104 (in Russian).

13. Miravitlles M., Cosío B.G., Arnedillo A. et al. A proposal for the withdrawal of inhaled corticosteroids in the clinical practice of chronic obstructive pulmonary disease. Respir. Res. 2017; 18 (1):198. DOI: 10.1186/s12931-017-0682-y.

14. Ye W., Guo X., Yang T., Han F. Systematic review of inhaled corticosteroid withdrawal effects in chronic obstructive pulmonary disease, and comparison with two “real-life” studies. J. Thorac. Dis. 2018; 10 (7): 4565–4573. DOI: 10.21037/jtd.2018.06.151.