Triple Therapy versus Dual or Monotherapy with Long-Acting Bronchodilators for Chronic Obstructive Pulmonary Disease. A Systematic Review and Meta-analysis.
Rationale: There is uncertainty on the use of using triple therapy (inhaled corticosteroids/long-acting β-agonist/long-acting muscarinic antagonist) inhaler therapy for patients with chronic obstructive pulmonary disease (COPD), who complain of dyspnea and/or exercise intolerance.Objectives: We cond...
| Publicado en: | Annals of the American Thoracic Society Vol. 17; no. 10; pp. 1308 - 1338 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Oxford University Press / USA
Oct2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=146313827&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 146313827 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 23296933 FUCV jtl: Annals of the American Thoracic Society issn: 23296933 maglogo: N pubinfo: dt: Oct2020 vid: 17 iid: 10 pid: 622 pub: Oxford University Press / USA artinfo: ui: 146313827 146313827 NLM32692253 146313827 10.1513/AnnalsATS.202001-023OC NLM32692253 146313827 ppf: 1308 ppct: 30 formats: tig: atl: Triple Therapy versus Dual or Monotherapy with Long-Acting Bronchodilators for Chronic Obstructive Pulmonary Disease. A Systematic Review and Meta-analysis. aug: au: Mammen, Manoj J. Lloyd, David R. Kumar, Sandeep Ahmed, Anum S. Pai, Vandana Kunadharaju, Rajesh Gupta, Shilpi Nici, Linda Aaron, Shawn D. Alexander, Paul E. affil: Jacobs School of Medicine and Biomedical Sciences, The State University of New York at Buffalo, Buffalo, New York sug: subj: Bronchodilator Agents Therapeutic Use Pulmonary Disease, Chronic Obstructive Drug Therapy Drug Therapy, Combination Adrenal Cortex Hormones Therapeutic Use Administration, Inhalation Human Muscarinic Antagonists Therapeutic Use Adrenergic beta-Agonists Therapeutic Use Comparative Studies Multicenter Studies Evaluation Research Validation Studies Scales Ferrans and Powers Quality of Life Index Exercise of Self-Care Agency Scale ab: Rationale: There is uncertainty on the use of using triple therapy (inhaled corticosteroids/long-acting β-agonist/long-acting muscarinic antagonist) inhaler therapy for patients with chronic obstructive pulmonary disease (COPD), who complain of dyspnea and/or exercise intolerance.Objectives: We conducted a systematic review and meta-analyses to estimate the safety and efficacy of using triple therapy compared with long-acting β-agonist/long-acting muscarinic antagonist dual therapy or monotherapy with a single long-acting bronchodilator in patients with stable COPD who complained of dyspnea and/or exercise intolerance.Methods: A search of MEDLINE, Embase, and the Cochrane Library databases was conducted for randomized controlled trials pertaining to the clinical question. A systematic approach was used to screen, abstract, and critically appraise the studies. The grading of recommendations assessment, development, and evaluation method was applied to rate the certainty/quality of the evidence.Results: Eleven studies were eligible for inclusion (n = 14,145 patients). Pairwise random-effects meta-analysis revealed an increase in risk of pneumonia (relative risk, 1.47; 95% confidence interval [95% CI], 1.20-1.80; P < 0.001) and decreased risk of acute exacerbations of COPD (AECOPDs) (relative risk, 0.75; 95% CI, 0.68-0.82; P < 0.001) with triple therapy compared with treatment with dual and monotherapy long-acting bronchodilator therapy. No significant difference in dyspnea scores (standardized mean difference, 0.09; 95% CI, -0.02 to 0.19; P = 0.09) or risk of hospitalization (rate ratio, 0.78; 95% CI, 0.58-1.06; P = 0.11) was noted. When subgroup analysis based on inhaler class was performed, no significant difference was noted between the groups in any of the critical outcomes studied. For patients with a history of one or more AECOPDs in the past year, triple therapy resulted in 230 fewer AECOPDs and 16 more cases of pneumonia per 1,000 patients.Conclusions: In patients with COPD who complain of dyspnea and/or exercise intolerance, triple therapy is not superior to maintenance long-acting bronchodilator therapy, except in patients with a history of one or more exacerbations in the past year, in whom the benefits of reduction in AECOPD outweigh the increased risk of pneumonia. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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