The effect of different inhaled drugs on the treatment of patients with frequent cough in chronic obstructive pulmonary disease
Objective To compare the therapeutic effects of different inhaled medications on patients with frequent cough in chronic obstructive pulmonary disease(COPD),including changes in symptoms and acute exacerbation.Methods This study was based on the RealDTC study,and the study subjects were stable COPD patients from the Department of Pulmonary and Critical Care Medicine,the Second Xiangya Hospital,Central South University from December 2016 to March 2023.The demographic characteristics,smoking status,history of biofuel exposure,history of acute exacerbation in the past year,lung function,COPD Assessment Test(CAT)score,modified British Medical Research Council Respiratory Difficulty Questionnaire(mMRC)score,and inhalation medication regimen of the patients were collected.Patients with frequent cough are defined as having a cough score of ≥2 in the first item of the CAT score.According to the type of inhaled medication,patients with frequent cough are divided into 1 long-acting muscarine anticholinergic(LAMA),long-acting β2 agonists(LABA)+LAMA,inhaled corticosteroids(ICS)+LABA,and ICS+LABA+LAMA groups.At the 6th month follow-up,CAT scores were collected and symptom control was evaluated,including minimum clinical improvement(MCID)(defined as a decrease of ≥2 points from baseline in CAT scores at the 6th month)and improvement in cough symptoms(defined as a decrease of ≥ 1 point from baseline in cough scores).During a one-year follow-up,the number of acute exacerbations was evaluated.The relationship between different inhaled medications and prognosis in patients with frequent cough in COPD was evaluated using multivariate logistic regression analysis.Results A total of 653 patients with frequent cough in COPD were included,with a CAT score of(16.4±6.1)and a cough score of 3(2,3).After 6 months of follow-up,403 patients(61.7％)achieved MCID,and 394 patients(60.3％)had improved cough symptoms;During a one-year follow-up,227 patients(34.8％)experienced acute exacerbation.After receiving inhalation medication treatment,the CAT scores and cough scores of four groups of patients with frequent cough,namely LAMA,LABA+LAMA,ICS+LABA,and ICS+LABA+LAMA,decreased compared to before treatment(all P＜0.05).There was a statistically significant difference in the proportion of ΔCAT score,MCID,and acute exacerbation among the four groups of LAMA,LABA+LAMA,ICS+LABA,and ICS+LABA+LAMA(all P＜0.05),while there was no statistically significant difference in the proportion of Δcough score and cough score reduction ≥1 point(all P＞0.05).The results of multivariate logistic regression analysis showed that compared with patients treated with LAMA or ICS+LABA drugs,patients with frequent cough in COPD treated with LABA+LAMA or ICS+LABA+LAMA drugs were more likely to achieve MCID and less likely to experience acute exacerbation(all P＜0.05).Conclusions Compared with LAMA or ICS+LABA,patients with frequent cough in COPD who receive LABA+LAMA or ICS+LABA+LAMA drug treatment are more likely to improve symptoms and have a lower risk of acute exacerbation.
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