Early COPD Exacerbation Treatment with Combination of ICS and LABA for Patients Presenting with Mild-to-Moderate Worsening of Dyspnea

Figures & data

Figure 1. Study flow diagram.

Table 1. Characteristics of study patients.

Variables	AECOPD (n = 27)	No AECOPD (n = 10)	Total (n = 37)
Age (in year) [mean (sd)]	66.6 (8.5)	67.3 (6.3)	66.8 (7.9)
Male gender [n (%)]	14 (52)	8 (80)	22 (60)
Race-Caucasian [n (%)]	27 (100)	10 (100)	37 (100)
Smoking status
Current-smoker [n (%)]	3 (11)	3 (30)	6 (16)
Ex-Smoker [n (%)]	24 (89)	7 (70)	31 (84)
Pack years [mean (sd)]	52 (21)	41 (20)	49 (21)
SpO2 (%) [mean (sd)]	95 (2)	95 (2)	95 (2)
FEV1-pre (L) [mean (sd)]	1.02 (0.40)	1.23 (0.65)	1.07 (0.48)
%FEV1PRED-pre [mean (sd)]	40 (14)	43 (19)	41 (15)
FEV1-post (L) [mean (sd)]	1.07 (0.42)	1.22 (0.60)	1.11 (0.47)
%FEV1PRED-post [mean (sd)]	42 (14)	42 (18)	42 (15)
FEV1/FVC-pre [mean (sd)]	0.45 (0.12)	44.81 (0.12)	0.45 (0.12)
FEV1/FVC-post [mean (sd)]	0.47 (0.12)	43.71 (0.13)	0.46 (0.12)
MRC (1 to 5) [n (%)]
2	10 (37)	5 (50)	15 (41)
3	7 (26)	3 (30)	10 (27)
4	9 (33)	2 (20)	11 (30)
5	1 (4)	0 (0)	1 (3)
Respiratory Medications [n (%)]
Salmeterol and Fluticasone BID 250 mcg	9 (33)	6 (60)	15 (41)
500 mcg	18 (67)	4 (40)	22 (60)
Tiotropium DIE 18 mcg	27 (100)	10 (100)	37 (100)
Salbutamol PRN 200 mcg	27 (100)	10 (100)	37 (100)

AECOPD: acute exacerbation of COPD; SpO₂: oxygen saturation determined by pulse oximeter; FEV₁: forced expiratory volume, 1 second; %FEV₁ PRED: FEV₁ expressed as a percentage of predicted normal; FVC: forced vital capacity; MRC: Medical Research Council dyspnea scale.

Table 2. Medication and health resources used for the AECOPD patients (n = 27).

Variables	N	%
AECOPD experienced during study	27	100
Doubling combination LABA/ICS Success^*	21	78
Success for those with 250 mcg increase	7	33
Success for those with 500 mcg increase	14	66
Treated with antibiotics	12	57
AECOPD experienced in the past 2 years	82	-
Medication used for past AECOPD
Only Antibiotics	4	5
Only Prednisone	7	9
Antibiotics and Prednisone	71	87
Emergency room visits required for AECOPD	19	23
Hospital admissions required for AECOPD	10	12

AECOPD: acute exacerbation of COPD.

^*Treatment Success of the intervention was defined as “no need of prednisone within 30 days of the onset (worsening of dyspnea) of an AECOPD”, and doubling combination of LABA/ICS (Salmeterol and Fluticasone Propionate) being safe with respect to the absence of cardiovascular events, pneumonia, emergency room visits and/or hospital admissions.

Table 3. Adherence to maintenance therapy based on Smartinhaler results for the study.

	AECOPD (n = 15)		No AECOPD (n = 7)		Total (n = 22)
Adherence to Combination of LABA/ICS^*^*	N	%	N	%	N	%
Missing morning dose only
≥10% of days	1	7	2	29	7	32
≥20% of days	0	0	2	29	2	9
Missing afternoon or evening dose only
≥ 10% of days	5	33	5	71	10	46
≥ 20% of days	1	7	3	43	4	18
Missing both
≥ 10% of days	6	40	1	14	7	32
≥ 20% of days	5	33	0	0	5	23
	Mean	Std	Mean	Std	Mean	Std
Total doses	859.67	404.14	1090.14	533.68	933.00	449.82
Dose per day	3.56	1.11	3.71	0.56	3.61	0.96

AECOPD: acute exacerbation of COPD.

* Salmeterol and Fluticasone Propionate.