Clinical and Functional Effects of Inhaled Dual Therapy Umeclidinium/Vilanterol in Patients with Chronic Obstructive Pulmonary Disease: A Real-Life Study

Overview

Journal Int J Chron Obstruct Pulmon Dis

Publisher Dove Medical Press

Specialty Pulmonary Medicine

Date 2023 Jun 1

PMID 37260547

Authors

Corrado Pelaia

Anna Ferrante Bannera

Fioramante Lello Rotundo

Francesco Giuseppe Tropea

Giuseppe Armentaro

Angelantonio Maglio

Angela Sciacqua

Alessandro Vatrella

Girolamo Pelaia

Affiliations

Soon will be listed here.

Abstract

Background: The pharmacological association umeclidinium/vilanterol (UMEC/VI) allows to implement a very effective dual bronchodilation in chronic obstructive pulmonary disease (COPD), thus optimizing bronchodilating therapy.

Methods: The main purpose of our real-world observational study was to evaluate in COPD patients the effects of UMEC/VI on lung function and respiratory symptoms. Functional and clinical parameters were assessed at baseline, and after 52 weeks of treatment with this combined double inhaled therapy.

Results: We enrolled 110 subjects suffering from COPD. A 12-month UMEC/VI treatment induced significant improvements in total lung capacity (TLC) (p < 0.05), and residual volume (RV) (p < 0.0001). Pulmonary deflation was paralleled by significant increases of forced expiratory volume in one second (FEV) (p < 0.0001), forced vital capacity (FVC) (p < 0.01), forced expiratory flow between 25% and 75% of FVC (FEF) (p < 0.0001) and diffusion capacity of the lung (DLCOcSB) (p < 0.05). In addition, in the same period, we also observed significant reductions of airway resistance including total resistance (R) (p < 0.0001) and specific effective resistance (sR) (p < 0.0001). Other improvements were detected with regard to modified British Medical Research Council (mMRC) questionnaire score (p < 0.0001), COPD Assessment Test (CAT) score (p < 0.0001), and COPD exacerbation rate (p < 0.0001). In particular, the reported changes of mMRC/CAT scores and COPD exacerbation numbers were significantly correlated with UMEC/VI-induced modifications of TLC, RV, FVC and FEV.

Conclusion: In conclusion, our study corroborates in a real-life context the effectiveness of UMEC/VI in COPD treatment. Indeed, our broad investigational strategy has allowed to better characterize the functional mechanisms underpinning the therapeutic properties of UMEC/VI association.

Citing Articles

Lung isolation-a personalized and clinically adapted approach to control bronchoscopy-associated acute massive airway hemorrhage.

Yang M, Zhou Y, Li H, Wei H, Cheng Q BMC Pulm Med. 2023; 23(1):483.

PMID: 38037018 PMC: 10691002. DOI: 10.1186/s12890-023-02780-2.

References

Gross N, Co E, Skorodin M . Cholinergic bronchomotor tone in COPD. Estimates of its amount in comparison with that in normal subjects. Chest. 1989; 96(5):984-7. DOI: 10.1378/chest.96.5.984. View

Cada D, Ingram K, Leonard J, Baker D . Umeclidinium bromide and vilanterol trifenatate inhalation powder. Hosp Pharm. 2014; 49(6):554-62. PMC: 4062736. DOI: 10.1310/hpj4906-554. View

Bestall J, Paul E, Garrod R, Garnham R, Jones P, Wedzicha J . Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999; 54(7):581-6. PMC: 1745516. DOI: 10.1136/thx.54.7.581. View

Barnes P, Burney P, Silverman E, Celli B, Vestbo J, Wedzicha J . Chronic obstructive pulmonary disease. Nat Rev Dis Primers. 2016; 1:15076. DOI: 10.1038/nrdp.2015.76. View

Ni Y, Yu Y, Dai R, Shi G . Diffusing capacity in chronic obstructive pulmonary disease assessment: A meta-analysis. Chron Respir Dis. 2021; 18:14799731211056340. PMC: 8649441. DOI: 10.1177/14799731211056340. View

Wedzicha J, Decramer M, Seemungal T . The role of bronchodilator treatment in the prevention of exacerbations of COPD. Eur Respir J. 2012; 40(6):1545-54. PMC: 3511775. DOI: 10.1183/09031936.00048912. View

Donohue J, Maleki-Yazdi M, Kilbride S, Mehta R, Kalberg C, Church A . Efficacy and safety of once-daily umeclidinium/vilanterol 62.5/25 mcg in COPD. Respir Med. 2013; 107(10):1538-46. DOI: 10.1016/j.rmed.2013.06.001. View

Maltais F, Bjermer L, Kerwin E, Jones P, Watkins M, Tombs L . Efficacy of umeclidinium/vilanterol versus umeclidinium and salmeterol monotherapies in symptomatic patients with COPD not receiving inhaled corticosteroids: the EMAX randomised trial. Respir Res. 2019; 20(1):238. PMC: 6821007. DOI: 10.1186/s12931-019-1193-9. View

Blanco I, Diego I, Bueno P, Casas-Maldonado F, Miravitlles M . Geographic distribution of COPD prevalence in the world displayed by Geographic Information System maps. Eur Respir J. 2019; 54(1). DOI: 10.1183/13993003.00610-2019. View

10.

Somlyo A, Somlyo A . Signal transduction and regulation in smooth muscle. Nature. 1994; 372(6503):231-6. DOI: 10.1038/372231a0. View

11.

Jones P, Harding G, Berry P, Wiklund I, Chen W, Leidy N . Development and first validation of the COPD Assessment Test. Eur Respir J. 2009; 34(3):648-54. DOI: 10.1183/09031936.00102509. View

12.

Matera M, Page C, Cazzola M . Novel bronchodilators for the treatment of chronic obstructive pulmonary disease. Trends Pharmacol Sci. 2011; 32(8):495-506. DOI: 10.1016/j.tips.2011.04.003. View

13.

Cazzola M, Tashkin D . Combination of formoterol and tiotropium in the treatment of COPD: effects on lung function. COPD. 2009; 6(5):404-15. DOI: 10.1080/15412550903156333. View

14.

Groneberg D, Quarcoo D, Frossard N, Fischer A . Neurogenic mechanisms in bronchial inflammatory diseases. Allergy. 2004; 59(11):1139-52. DOI: 10.1111/j.1398-9995.2004.00665.x. View

15.

ODonnell D, Laveneziana P . The clinical importance of dynamic lung hyperinflation in COPD. COPD. 2007; 3(4):219-32. DOI: 10.1080/15412550600977478. View

16.

Rogliani P, Calzetta L, Braido F, Cazzola M, Clini E, Pelaia G . LABA/LAMA fixed-dose combinations in patients with COPD: a systematic review. Int J Chron Obstruct Pulmon Dis. 2018; 13:3115-3130. PMC: 6174911. DOI: 10.2147/COPD.S170606. View

17.

Coulson F, Fryer A . Muscarinic acetylcholine receptors and airway diseases. Pharmacol Ther. 2003; 98(1):59-69. DOI: 10.1016/s0163-7258(03)00004-4. View

18.

Maleki-Yazdi M, Kaelin T, Richard N, Zvarich M, Church A . Efficacy and safety of umeclidinium/vilanterol 62.5/25 mcg and tiotropium 18 mcg in chronic obstructive pulmonary disease: results of a 24-week, randomized, controlled trial. Respir Med. 2014; 108(12):1752-60. DOI: 10.1016/j.rmed.2014.10.002. View

19.

Hall I . Second messengers, ion channels and pharmacology of airway smooth muscle. Eur Respir J. 2000; 15(6):1120-7. DOI: 10.1034/j.1399-3003.2000.01523.x. View

20.

Kerwin E, Kalberg C, Galkin D, Zhu C, Church A, Riley J . Umeclidinium/vilanterol as step-up therapy from tiotropium in patients with moderate COPD: a randomized, parallel-group, 12-week study. Int J Chron Obstruct Pulmon Dis. 2017; 12:745-755. PMC: 5338844. DOI: 10.2147/COPD.S119032. View