Additive Effect of Inhaled Corticosteroid (ICS) On Patients with COPD Receiving Long-Acting Muscarinic Antagonist (LAMA)/Long-Acting Β2-Agonist (LABA): A Single-Center Observational Study

Background: To evaluate the efficacy of inhaled corticosteroid (ICS) as add-on to long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) in COPD patients.Methods: Of all COPD patients treated with LAMA/LABA (LAMA, Spiriva Respimat® 2.5 µg; LABA, Serevent Rotadisk® 50) therapy for 4 weeks or longer in whom LABA therapy was replaced with ICS/LABA therapy (Advair Diskus® 250/50) between April 2011 and April 2018, eligible patients receiving LAMA/LABA were evaluated for pulmonary function, SF-36, St. George's Respiratory Questionnaire, COPD Assessment Test, modified Medical Research Council scores, and airway resistance, from 1 week before the day on which they had been switched from LAMA/LABA to LAMA/LABA/ICS until more than 4 but less than 5 weeks after switching, to gain insight into the effect and safety of ICS in COPD.Results: In 37 men (mean, 72.46 ± 7.75 years old) analyzed in the study, none of the parameters in pulmonary function tests were significant (mean difference in FEV1.0 from baseline, +0.0080, P = 0.68; FEV1.0%, +0.13, P = 0.92; and FVC, -0.26, P = 0.42), while the impedance-oscillation system showed significant changes in Fres (mean difference from baseline, -2.51, P ≤ 0.0001) as well as in BP scores in SGRQ (mean difference from baseline, -7.03, P = 0.031).Conclusion: ICS as add-on to LAMA/LABA reduces airway elastic to inertial resistance ratios which may lead to structural airway improvements in COPD patients.Keywords: chronic obstructive pulmonary disease, impedance-oscillation system (ios), airway resistance, inhaled corticosteroid (ics), long-acting muscarinic antagonist (lama), long-acting β2-agonist (laba).