A NEW multicenter study, TOReTO, has shown that dual bronchodilator therapy can help reduce exacerbations in patients with chronic obstructive pulmonary disease (COPD), with notable differences in efficacy between current and former smokers. The study offers real-world insights into how long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) combinations work across these groups.
The TOReTO trial involved 967 patients using three LABA/LAMA therapies: tiotropium/olodaterol (Tio/Olo), umeclidinium/vilanterol (Umec/Vi), and glycopyrronium/formoterol (Gly/Fo). Researchers assessed lung function, exacerbation frequency, and symptom control, specifically comparing outcomes between current and former smokers. Propensity score matching (PSM) was applied to account for patient baseline differences.
The results showed that while dual bronchodilator therapy helped maintain stable COPD symptoms across all patient groups, the timing and frequency of acute exacerbations varied by smoking status. In current smokers, the time to first exacerbation and exacerbation rates differed significantly depending on the chosen therapy, with Umec/Vi showing a stronger effect (p=0.0114). For former smokers, however, there were no significant differences among the three LABA/LAMA therapies in reducing exacerbations, suggesting that the effectiveness of these combinations is relatively consistent in those who have quit smoking.
Although the study’s non-randomised design calls for careful interpretation, these findings highlight the potential for dual bronchodilator therapy to tailor COPD management based on smoking status, particularly in reducing exacerbations in current smokers. Further research is planned to refine these insights, potentially enhancing the personalisation of COPD care for better patient outcomes.
Reference
Lai YT et al. Benefit of dual bronchodilator therapy on exacerbations in former and current smokers with chronic obstructive pulmonary disease in real-world clinical practice: a multicenter validation study (TOReTO). Respir Res. 2024;25:377.
