Early initiation of bronchodilators may delay first COPD exacerbation

A new study published in BMC Journal of Respiratory Research shows that initiation of long-acting bronchodilators within 30 days of the diagnosis of chronic obstructive pulmonary disease (COPD) provided favorable outcomes..

It is uncertain if early therapy beginning with inhaled long-acting bronchodilators reduces exacerbations of chronic obstructive pulmonary disease better than delayed treatment commencement. In order to determine if initiating long-acting bronchodilator medication within 30 days of a COPD diagnosis lowers the likelihood of exacerbations in COPD patients, Hideyasu Yamada undertook this study.

Based on data from claims and electronic medical records that were retrieved from the Real World Data database, this study was a retrospective cohort study of COPD patients. The first verified inpatient or outpatient diagnosis of COPD between January 1, 2005, and December 31, 2018, was the index date. Participants who had COPD without a diagnosis of asthma and were under 40 years old at the index date were included. Patients were divided into two groups: "rapid therapy" patients who began inhaling long-acting bronchodilator medication within the first 30 days, and "delayed therapy" patients who did not. Both the entire population and those stratified by COPD phenotype, including chronic bronchitis (CB) and emphysema, were studied for the period of time from day 30 post-diagnosis to the initial exacerbation and the annual exacerbation rate (AER).

The key findings of this study were:

1. Time to first exacerbation was longer in the quick therapy group (n = 1466) compared to the delayed therapy group (n = 1516), and yearly rates of moderate or severe exacerbations were lower (rate ratio 0.74; 95% confidence interval [CI] [0.65, 0.84]).

2. In the subgroups of patients with CB or emphysema, timely treatment reduced AERs and lengthened time to first exacerbation.

This is the first study to show a link between the early use of bronchodilators and good clinical outcomes in COPD patients. The clinical results in individuals with CB or emphysema were favorably impacted by starting bronchodilator medication within 30 days of diagnosis. Patients should be urged to start using bronchodilators as soon as possible since timing is a crucial component in preventing exacerbations in the future.

Reference: 

Yamada, H., Matsumoto, I., Makita, N., Arita, Y., Hayashi, N., Mitsuoka, K., Tashiro, N., & Hizawa, N. (2022). Effect of timing of bronchodilator therapy initiation on exacerbations in patients with chronic obstructive pulmonary disease: a retrospective cohort study. In Respiratory Research (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12931-022-02184-6