Changes in Symptoms and Lung Function During Three Months of Individually Tailored Inhaled Therapy in Chronic Obstructive Pulmonary Disease: A Prospective Observational Cohort Study
- 1Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana 01230, Türkiye
- 2Department of Family Medicine, Adana City Research and Training Hospital, Adana 01230, Türkiye
- 3Department of Public Health, Adana City Research and Training Hospital, Adana 01230, Türkiye
Abstract
Background. Randomised controlled trials have established what individual inhaled regimens can achieve in chronic obstructive pulmonary disease (COPD) under controlled conditions, but they recruit selected populations and enforce protocol-driven follow-up. How patients fare on regimens chosen individually for them in everyday care is less well characterised. Objective. To assess the change in symptoms and lung function over three months in a prospective cohort of patients with COPD whose inhaled treatment was tailored to the individual by the attending physician. Methods. Consecutive adults with stable, spirometrically confirmed COPD attending a single internal-medicine clinic were assessed at baseline and reassessed approximately three months later. Baseline regimens were short-acting beta2-agonist/short-acting muscarinic antagonist (SABA/SAMA), long-acting muscarinic antagonist (LAMA), long-acting beta2-agonist (LABA), LABA plus inhaled corticosteroid (ICS), LABA plus LAMA, or LABA plus LAMA plus ICS. The primary outcomes were the within-participant change in COPD Assessment Test (CAT) score and in forced expiratory volume in one second (FEV1) % predicted. Secondary outcomes were the proportion achieving the CAT minimal clinically important difference (MCID, defined as a reduction of at least two points), the proportion achieving a six-minute walk distance (6MWD) improvement of at least 30 m, change in modified Medical Research Council (mMRC) dyspnoea grade, body mass index–airflow obstruction–dyspnoea–exercise capacity (BODE) and age–dyspnoea–obstruction (ADO) indices, and clinical events. Paired changes were analysed with paired t-tests or Wilcoxon signed-rank tests and are reported with 95% confidence intervals (CIs). Results. Three hundred participants were enrolled. Recorded GOLD groups were A (n = 69), B (n = 158) and E (n = 73). Paired CAT and FEV1 data were available for 276 (92.0%) and 257 (85.7%) participants, all of whom were reassessed between 84 and 98 days after baseline (median 91 days). Across the cohort, mean CAT fell by 3.93 points (95% CI −4.43 to −3.44) and mean FEV1 rose by 2.20 percentage points (95% CI 1.78 to 2.63); one hundred and ninety-five of 276 participants (70.7%) reached the CAT MCID and 98 of 244 (40.2%) achieved a 6MWD gain of at least 30 m. Improvement was observed with every long-acting regimen. Participants receiving LABA + ICS improved by 4.18 CAT points (95% CI −5.24 to −3.12; p < 0.001) and 3.06 FEV1 percentage points (95% CI 2.16 to 3.95; p < 0.001), with 82.1% reaching the CAT MCID—a magnitude similar to that observed on LABA+LAMA. Participants on SABA/SAMA alone showed no improvement in either outcome. Sixty-three exacerbations, eleven hospitalisations and four cases of pneumonia occurred. Conclusions. During a reassessment interval of 84 to 98 days, patients with COPD receiving individually tailored long-acting inhaled therapy showed improvement in symptoms and lung function that exceeded the established MCID for the CAT, including patients treated with LABA+ICS. The study had no concurrent control group, no randomisation and no adjustment for baseline differences between regimens; the observed changes therefore describe the course of treated patients and cannot be attributed to any specific regimen.
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BibTeX
@article{isik2026changes,
title = {{Changes in Symptoms and Lung Function During Three Months of Individually Tailored Inhaled Therapy in Chronic Obstructive Pulmonary Disease: A Prospective Observational Cohort Study}},
author = {Bektas Isik and Hilmi Erdem Sumbul and Huseyin Ali Ozturk and Begum Seyda Avci and Erdinc Gulumsek and Merve Sumbul and Irfan Alisan and Ahmet Gazi Mustan and Fatih Necip Arici and Cisem Yilmaz and Cahit Dincer and Okan Pirinci and Ramazan Azim Okyay},
journal = {Journal of clinical medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15197722},
url = {https://europepmc.org/article/PMC/PMC13666111},
note = {CC BY},
}
RIS
TY - JOUR
TI - Changes in Symptoms and Lung Function During Three Months of Individually Tailored Inhaled Therapy in Chronic Obstructive Pulmonary Disease: A Prospective Observational Cohort Study
AU - Bektas Isik
AU - Hilmi Erdem Sumbul
AU - Huseyin Ali Ozturk
AU - Begum Seyda Avci
AU - Erdinc Gulumsek
AU - Merve Sumbul
AU - Irfan Alisan
AU - Ahmet Gazi Mustan
AU - Fatih Necip Arici
AU - Cisem Yilmaz
AU - Cahit Dincer
AU - Okan Pirinci
AU - Ramazan Azim Okyay
PY - 2026
DA - 2026/10/01
JO - Journal of clinical medicine
DO - 10.3390/jcm15197722
UR - https://europepmc.org/article/PMC/PMC13666111
AB - Background. Randomised controlled trials have established what individual inhaled regimens can achieve in chronic obstructive pulmonary disease (COPD) under controlled conditions, but they recruit selected populations and enforce protocol-driven follow-up. How patients fare on regimens chosen individually for them in everyday care is less well characterised. Objective. To assess the change in symptoms and lung function over three months in a prospective cohort of patients with COPD whose inhaled treatment was tailored to the individual by the attending physician. Methods. Consecutive adults with stable, spirometrically confirmed COPD attending a single internal-medicine clinic were assessed at baseline and reassessed approximately three months later. Baseline regimens were short-acting beta2-agonist/short-acting muscarinic antagonist (SABA/SAMA), long-acting muscarinic antagonist (LAMA), long-acting beta2-agonist (LABA), LABA plus inhaled corticosteroid (ICS), LABA plus LAMA, or LABA plus LAMA plus ICS. The primary outcomes were the within-participant change in COPD Assessment Test (CAT) score and in forced expiratory volume in one second (FEV1) % predicted. Secondary outcomes were the proportion achieving the CAT minimal clinically important difference (MCID, defined as a reduction of at least two points), the proportion achieving a six-minute walk distance (6MWD) improvement of at least 30 m, change in modified Medical Research Council (mMRC) dyspnoea grade, body mass index–airflow obstruction–dyspnoea–exercise capacity (BODE) and age–dyspnoea–obstruction (ADO) indices, and clinical events. Paired changes were analysed with paired t-tests or Wilcoxon signed-rank tests and are reported with 95% confidence intervals (CIs). Results. Three hundred participants were enrolled. Recorded GOLD groups were A (n = 69), B (n = 158) and E (n = 73). Paired CAT and FEV1 data were available for 276 (92.0%) and 257 (85.7%) participants, all of whom were reassessed between 84 and 98 days after baseline (median 91 days). Across the cohort, mean CAT fell by 3.93 points (95% CI −4.43 to −3.44) and mean FEV1 rose by 2.20 percentage points (95% CI 1.78 to 2.63); one hundred and ninety-five of 276 participants (70.7%) reached the CAT MCID and 98 of 244 (40.2%) achieved a 6MWD gain of at least 30 m. Improvement was observed with every long-acting regimen. Participants receiving LABA + ICS improved by 4.18 CAT points (95% CI −5.24 to −3.12; p < 0.001) and 3.06 FEV1 percentage points (95% CI 2.16 to 3.95; p < 0.001), with 82.1% reaching the CAT MCID—a magnitude similar to that observed on LABA+LAMA. Participants on SABA/SAMA alone showed no improvement in either outcome. Sixty-three exacerbations, eleven hospitalisations and four cases of pneumonia occurred. Conclusions. During a reassessment interval of 84 to 98 days, patients with COPD receiving individually tailored long-acting inhaled therapy showed improvement in symptoms and lung function that exceeded the established MCID for the CAT, including patients treated with LABA+ICS. The study had no concurrent control group, no randomisation and no adjustment for baseline differences between regimens; the observed changes therefore describe the course of treated patients and cannot be attributed to any specific regimen.
SN - 2077-0383
ER -