Therapeutic Response to Single-Inhaler Triple Therapies in Moderate-to-Severe COPD

COPD is characterized by progressive and irreversible air flow limitations. Single-inhaler therapies (SITTs) incorporating an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting β -agonist have been shown to effectively alleviate symptoms and improve lung function. Fluticasone-furoate/umeclidinium/vilanterol (F/U/V) and budesonide/glycopyrronium/formoterol (B/G/F) are available as SITT in Japan. However, the clinical differences between these 2 combinations and the predictors of their proper use have not been established. This study aimed to identify the subject characteristics that could predict the effectiveness of inhaler therapy. We assessed the pulmonary function test results of subjects with COPD before and one month after using F/U/V and B/G/F as SITT. Subjects with a difference of 100 mL or more in the FEV after treatment with pre-SITT were extracted and divided into the F/U/V effect and no-effect group and B/G/F effect and no-effect group to examine the factors associated with positive outcomes with each inhaler. F/U/V and B/G/F significantly improved the inspiratory capacity (IC), %IC, FVC, and %FEV when compared to pre-intervention values ( < .001, = .001, = .007, = .009, respectively, for F/U/V; and = .006, = .008, = .038, = .005, respectively, for B/G/F). Factors associated with FEV improvement in F/U/V included lower %IC (odds ratio 0.97 [95% CI 0.94-0.99], = .03) and a higher modified Medical Research Council (mMRC) dyspnea score (2.36 [1.27-4.70], < .01). In addition, a higher %IC (1.03 [1.00-1.06], = .02) and lower mMRC dyspnea score (0.55 [0.28-0.99], = .041) were predictors for the effectiveness of B/G/F. Our results showed that SITT significantly improved the IC, %IC, FVC, and %FEV when compared to pre-intervention and that F/U/V was more effective in subjects with severe symptoms, whereas B/G/F was more effective in subjects with mild symptoms.