Which bronchodilator to choose if a patient with chronic obstructive pulmonary disease continues to smoke?

From 30 to 43% of smoking patients with chronic obstructive pulmonary disease (COPD) cannot give up nicotine despite the diagnosis and deterioration of health. Most of the publications related to the treatment of COPD do not distinguish smoking patients into a separate group. The aim of this study is a comparative analysis of the effectiveness of long-acting muscarinic antagonists (LAMA), LAMA/long-acting β2 -agonists (LABA) in smoking patients.

Methods. The study involved 121 patients with a high degree of nicotine addiction and irreversible bronchial obstruction. All the patients continued to receive bronchodilator therapy. The respondents were divided into two groups: patients who quit smoking and patients who continued to smoke. In turn, each group was divided into two subgroups depending on the treatment – LAMA (Tiotropium 5 μg and Glycopyrronium 50 μg) and LAMA/LABA (tiotropium/olodaterol 5/5 μg and glycopyrronium/idacaterol 50/110 μg). We used the changes of FEV1 and the dynamics of CAT (COPD Assessment Test) as the comparison criteria.

Results. The results of the CAT and spirometry showed a tendency to improve in both groups, regardless of the treatment regimen. However, the improvement in symptoms and spirometry parameters were more pronounced in the group of patients who quit smoking: –1 and –11 points, respectively (p < 0.05) and 12 and 23%, respectively (p < 0.05). Comparison of the efficacy of various treatment regimens in the group of smoking patients showed there was no statistically significant difference between LAMA and LAMA/LABA neither in spirometry parameters (11.45 and 13.1%; p < 0.05), nor in the CAT scores (–1.5 and –1.67; p < 0.05). However, combination therapy (LAMA/LABA) was more effective than monotherapy (LAMA) in the group of patients who quit smoking both according to spirometry (25.5 and 13%, respectively; p < 0.05) and CAT (–12.3 and –5.9, respectively; p < 0.05). There was no statistically significant difference between the active substances both in the monotherapy group (tiotropium/glycopyrronium) and in the combination group (tiotropium/olodaterol and glycopyrronium/indacaterol).

Conclusion. According to CAT and spirometry, there was no difference between tiotropium and glycopyrronium, nor was there a difference between fixed-dose combinations of tiotropium/olodaterol and glycopyrronium/ indacaterol (both in the group of smokers and in the group of non-smokers). Smoking cessation is key to improving both spirometry and CAT results.

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