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A Randomized, Noninferiority Trial Comparing ICS thorn LABA with ICS plus LABA plus LAMA in Asthma-COPD Overlap (ACO) Treatment: The ACO Treatment with Optimal Medications (ATOMIC) Study

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Abstract
BACKGROUND: Current guidelines for the treatment of asthma and chronic obstructive pulmonary disease overlap (ACO) recommend initial treatment using inhaled corticosteroids (ICSs) plus 1 or more bronchodilators.

OBJECTIVE: To clarify which therapeutic effect is better between the ICS D long-acting beta(2) agonist (LABA) and ICS D LABA D long-acting muscarinic antagonist (LAMA) treatment in patients with ACO.

METHODS: We conducted a multicenter, 48-week, randomized, noninferiority trial. Patients with ACO were enrolled if they were treated with a moderate to high dose of ICS D LABA. In total, 303 patients were involved in the present trial, with 149 receiving ICS D LABA D LAMA. The primary end point was the time to first exacerbation. Secondary outcomes included changes in FEV1, forced vital capacity, FEV1/forced vital capacity ratio, asthma control, blood eosinophil count, and fractional exhaled nitric oxide.

RESULTS: In the ICS D LABA treatment group, 29 of 154 patients (18.83%) experienced exacerbation, whereas 28 of 149 patients (18.79%) experienced exacerbation in the ICS D LABA D LAMA treatment group. The results of this noninferiority study were ultimately inconclusive (hazard ratio, 1.1; 95% CI, 0.66-1.84). However, the patients treated with the addition of LAMA showed significant improvements in FEV1 and forced vital capacity (P <.001). Asthma control did not improve in either group.

CONCLUSIONS: Although this study was unable to conclude that ICS D LABA treatment is not inferior to ICS D LABA D LAMA in terms of exacerbation, it is obvious that the ICS D LABADLAMA treatment group had improved lung function in ACO. (C) 2020 American Academy of Allergy, Asthma Immunology
Author(s)
권재우김민혜김상하김상훈김새훈김솔미김수정김정현김주희김태범김희규남영희문지용박서영박소영박찬선신유섭양민석윤선영이재천이태훈장안수정재우최정희허규영
Issued Date
2021
Type
Article
Keyword
Acetylcholine receptors (muscarinic)Airway managementAsthmaAsthma-COPD overlapBronchodilatorsChronic obstructive pulmonary diseaseCorticoidsDisease Drug dosagesGenotype &amp; phenotypeICSLABALAMALeukocytes (eosinophilic)Lung diseasesNitric oxideObstructive lung diseaseRespiratory functionTriple therapyTuberculosis
DOI
10.1016/j.jaip.2020.09.066
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8119
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2460770871&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,A%20Randomized,%20Noninferiority%20Trial%20Comparing%20ICS%20thorn%20LABA%20with%20ICS%20plus%20LABA%20plus%20LAMA%20in%20Asthma-COPD%20Overlap%20(ACO)%20Treatment:%20The%20ACO%20Treatment%20with%20Optimal%20Medications%20(ATOMIC)%20Study&amp;offset=0&amp;pcAvailability=true
Publisher
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
Location
미국
Language
한국어
ISSN
2213-2198
Citation Volume
9
Citation Number
3
Citation Start Page
1304
Citation End Page
1304
Appears in Collections:
Medicine > Medicine
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