Inhaled triple therapy in individuals with Chronic Obstructive Pulmonary Disease and indications of pulmonary rehabilitation

doi:10.1016/j.ejim.2022.08.011

European Journal of Internal Medicine

Volume 105, November 2022, Pages 125-127

https://doi.org/10.1016/j.ejim.2022.08.011 Get rights and content

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Funding sources

This work was partially funded by the Ricerca Corrente scheme of the Ministry of Health, Italy. The study also received partial unrestricted funding from Chiesi Farmaceutici SpA, Italy.

CRediT authorship contribution statement

Michele Vitacca: Conceptualization, Methodology, Formal analysis, Investigation, Writing – original draft, Writing – review & editing, Supervision. Mara Paneroni: Methodology, Formal analysis, Data curation, Visualization. Antonio Spanevello: Investigation, Supervision. Piero Ceriana: Investigation, Supervision. Nicolino Ambrosino: Methodology, Writing – original draft, Writing – review & editing, Supervision.

Declaration of Competing Interest

The authors have no conflict of interest to disclose related to this manuscript.

Acknowledgments

The Authors thank Paolo De Nardi, Beatrice Salvi, Luigino Rizzello and the Maugeri Respiratory Network for data collection/evaluation/supervision and Adriana Olivares for her technical assistance and editing.

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Initiation of triple therapy maintenance treatment among patients with COPD
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Cited by (5)

Gender and Age as Determinants of Success of Pulmonary Rehabilitation in Individuals With Chronic Obstructive Pulmonary Disease
2023, Archivos de Bronconeumologia
Airflow grades, outcome measures and response to pulmonary rehabilitation in individuals after an exacerbation of severe chronic obstructive pulmonary disease
2023, European Journal of Internal Medicine
Citation Excerpt :
The MCID has been reported to be 2 points [26]. The ICS Maugeri network PR units share an in-hospital program supervised by a multidisciplinary team consisting of chest physicians, nurses, physical therapists, dieticians, and psychologists as previously described [13–16]. The standard program includes the optimization of drug therapy, education, nutritional programs, and psychosocial counselling when appropriate, and at least 22 sessions over a period of 3–4 weeks of supervised and incremental exercise training according to Maltais et al. [27] until performing 30 min continuous cycling at 50–70% of the maximal load calculated on the baseline 6MWT according to Luxton et al. [28].
Individuals with COPD may be staged according to symptoms and exacerbation history (GOLD groups: A-D) and on airflow obstruction (GOLD grades: 1–4). Guidelines recommend pulmonary rehabilitation (PR) for these individuals, including those recovering from an exacerbation (ECOPD)
To evaluate whether in individuals with clinically severe COPD, recovering from an ECOPD, the effect size of an in-hospital PR program would be affected by airflow severity grades and assessed outcome measures.
Retrospective, multicentre study. Participants were compared according to different GOLD airflow grades. In addition to the MRC dyspnoea scale, six-minute walking distance test and COPD assessment test (CAT), Barthel dyspnoea index (Bid), and Short Physical Performance Battery (SPPB) were assessed, evaluating the proportion of individuals reaching the minimum clinically important difference (MCID) (responders).
Data of 479 individuals, completing the program were evaluated. Most of the participants were allocated in GOLD grades 4, (57.6%) and 3 (22.1%). All outcome measures significantly improved after PR (p < 0.05), without any significant difference in the proportion of responders in any measure.
in individuals with severe COPD, recovering from ECOPD the success rate of PR does not depend on airflow severity, or outcome measure assessed. In addition to the most used outcome measures, also Bid and SPPB are sensitive to PR.
Effectiveness of pulmonary rehabilitation in individuals with Chronic Obstructive Pulmonary Disease according to inhaled therapy: The Maugeri study
2022, Respiratory Medicine
Citation Excerpt :
As a retrospective analysis, the study was not registered. Part of the baseline data has been submitted elsewhere [7]. This study was conducted on data of individuals with a reported diagnosis of COPD (DRG 88) consecutively admitted between July 1st, 2018 to December 31st, 2021 to the hospitals of the ICS Maugeri network (Lumezzane, Pavia, Veruno, Tradate - Italy), referral hospitals for pulmonary rehabilitation, diagnosis and care of chronic diseases [8].
Real-life studies report discordant prescribing of inhaled triple therapy (TT) among individuals with COPD. Guidelines recommend pulmonary rehabilitation (PR) for persistent breathlessness and/or exercise limitation. This real-life study aimed to assess the effects of in-patient PR in individuals under TT as compared to other inhaled therapies (no TT).
Multicentric, retrospective analysis of data from individuals admitted to in-hospital PR. Baseline characteristics were recorded and lung function was assessed. Outcome measures were: 6-min walking test (6MWT: primary outcome), Medical Research Council (MRC) scale for dyspnoea, and COPD assessment test (CAT).
Data of pre and post program 6MWT of 1139 individuals were available. Pulmonary rehabilitation resulted in significant improvement in 6MWT in both groups, however, the effect size (by 54.3 ± 69.7 vs 42.5 ± 64.2 m, p = 0.004) and proportion of individuals reaching the minimal clinically important difference (MCID) of 6MWT (64.2%, vs 54.3%, p = 0.001) were higher in TT group. Both groups significantly improved also the other outcome measures. The significant independent predictors of reaching the MCID of 6MWT were hospital provenience, TT use, and high eosinophils count.
Pulmonary rehabilitation results in significant benefits in individuals with COPD irrespective of the use of TT. However, individuals under TT report larger benefits in exercise tolerance than those under no TT.
Pulmonary rehabilitation and risk of fall in elderly with chronic obstructive pulmonary disease
2024, Panminerva Medica
Effect of Pulmonary Rehabilitation on COPD Assessment Test Items in Individuals Classified as GOLD Group e
2023, Respiration

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Letter to the EditorInhaled triple therapy in individuals with Chronic Obstructive Pulmonary Disease and indications of pulmonary rehabilitation

Section snippets

Funding sources

CRediT authorship contribution statement

Declaration of Competing Interest

Acknowledgments

Pulmonology

Initiation of triple therapy maintenance treatment among patients with COPD

Am J Manag Care

Standardisation of spirometry

Eur Respir J

Standardized questionnaire on respiratory symptoms: a statement prepared and approved by the MRC committee on the etiology of chronic bronchitis (MRC breathlessness score)

Br Med J

Letter to the Editor
Inhaled triple therapy in individuals with Chronic Obstructive Pulmonary Disease and indications of pulmonary rehabilitation