A Randomized, Noninferiority Trial Comparing ICS + LABA with ICS + LABA + LAMA in Asthma-COPD Overlap (ACO) Treatment: The ACO Treatment with Optimal Medications (ATOMIC) Study
- Authors
- Park, S.-Y.; Kim, S.; Kim, J.-H.; Kim, S.-H.; Lee, T.; Yoon, S.-Y.; Kim, M.-H.; Moon, J.-Y.; Yang, M.-S.; Jung, J.-W.; Kim, J.-H.; Choi, J.-H.; Park, C.S.; Kim, S.; Lee, J.; Kwon, J.-W.; Hur, G.Y.; Kim, S.-H.; Kim, H.-K.; Shin, Y.S.; Kim, S.-H.; Nam, Y.-H.; Jang, A.-S.; Park, S.Y.; Kim, T.-B.; Song, W.-J.; Kwon, H.-S.; Cho, Y.S.; Moon, H.-B.; Ki, T.-B.; Seo, B.; Choi, B.-W.; Cho, Y.-J.; Park, S.Y.; Jin, H.J.; Park, H.-K.; Lee, S.M.; Kang, S.-Y.; Ban, G.-Y.; Cohort for Reality and Evolution of Adult Asthma in Korea (COREA) Study Group
- Issue Date
- Mar-2021
- Publisher
- American Academy of Allergy, Asthma and Immunology
- Keywords
- Asthma-COPD overlap; ICS; LABA; LAMA; Triple therapy
- Citation
- Journal of Allergy and Clinical Immunology: In Practice, v.9, no.3, pp 1304 - +
- Indexed
- SCIE
SCOPUS
- Journal Title
- Journal of Allergy and Clinical Immunology: In Practice
- Volume
- 9
- Number
- 3
- Start Page
- 1304
- End Page
- +
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/51908
- DOI
- 10.1016/j.jaip.2020.09.066
- ISSN
- 2213-2198
2213-2201
- 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 + long-acting β2 agonist (LABA) and ICS + LABA + 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 + LABA. In total, 303 patients were involved in the present trial, with 149 receiving ICS + LABA + 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 + LABA treatment group, 29 of 154 patients (18.83%) experienced exacerbation, whereas 28 of 149 patients (18.79%) experienced exacerbation in the ICS + LABA + 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 + LABA treatment is not inferior to ICS + LABA + LAMA in terms of exacerbation, it is obvious that the ICS + LABA + LAMA treatment group had improved lung function in ACO. © 2020 American Academy of Allergy, Asthma & Immunology
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Collections - 2. Clinical Science > Department of Pulmonary, Allergy, and Critical Care Medicine > 1. Journal Articles
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