Dual bronchodilation improves ventilation dynamics in COPD patients

Novel results from the CLAIM study demonstrate better pulmonary ventilation/perfusion match and ventilation dynamics when hyperinflated chronic obstructive pulmonary disease (COPD) patients are treated with indacaterol/glycopyrronium.

Dual bronchodilation in combination with a long-acting β agonist and a muscarinic receptor antagonist was found to decline hyperinflation and increase heart function in the CLAIM trial [1]. The study included 62 COPD patients with hyperinflation expressed by a residual volume of >135% at baseline. All patients were ≥40 years old and had smoked for ≥10 pack-years. The new investigation analysed treatment effects on pulmonary ventilation/perfusion match (VQM) and regional ventilation dynamics by comparing indacaterol/glycopyrronium versus placebo in the CLAIM cohort [2].

Participants were randomised 1:1. Group 1 first received indacaterol/glycopyrronium at a dosage of 110/50 μg per day for 14 days followed by another 14 days of placebo washout. Group 2 was treated in the same way but started with 14 days of placebo switching to the combination afterwards. Perfusion and ventilation of the lung regions was determined by phase-resolved functional lung MRI. An intra-subject healthy reference was used as base for ratings from 0–100% of regional MRI flow-volume curves during continuous tidal volume breathing. VQM was calculated applying a threshold of 20 ml/min/100ml for perfusion and 90% of correlation metric.

As a result, the indacaterol/glycopyrronium treatment led to a 9.7% greater VQM compared with placebo (P<0.0001). Those changes were also associated with significant improvements in left ventricular end-diastolic volume (P=0.015), forced expiratory volume 1 (P<0.0001), and forced vital capacity (P=0.004). The investigators observed a likelihood that the enhanced VQM and regional ventilation dynamics will result in increased oxygenation and subsequently augmented microvascular function as well as ventricular filling.

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   1. Hohlfeld JM, et al. Lancet Respir Med. 2018 May;6(5):368-378.
   2. Voskrebenzev A, et al. PA 3381. ERS 2019, 29 Sept-2 Oct, Madrid, Spain.

 



Posted on 28 November 201917 March 2021