Effects of Direct Switching Dual Bronchodilators between Dry Powder and Soft Mist Inhalers in COPD Patients

Objective: Dual bronchodilation with long-acting muscarinic antagonist and long-acting β2-agonist combinations are available worldwide in COPD patients. However, the choice of agents remains under debate. We hypothesized that switching devices between dry powder and soft mist inhalers without a wash-out period to mimic clinical practice would improve clinical symptoms and lung function. The aim of this study was to examine the effects of switching between once-daily glycopyrronium/indacaterol (GLY/IND) or umeclidinium/vilanterol (UMEC/VI), dry powder inhalers, and tiotropium/olodaterol (TIO/OLO), a soft mist inhaler, in COPD patients. Methods: This was a prospective, open-label, 8-week, observational study with follow-up. Subjects included 57 COPD patients, who attended outpatient clinics at Shizuoka General Hospital for routine check-ups between February and December 2015, receiving GLY/IND (50/110 μg) or UMEC/VI (62.5/25 μg). After an 8-week run-in period, medications were switched to TIO/OLO (5/5 μg). Study outcomes included patient’s global rating (PGR), modified MRC (mMRC), COPD assessment test (CAT), and spirometric and forced oscillatory parameters after 8 weeks. PGR used in this study was a 7-point scale ranging from 1 to 7, with 4 in the middle. Patients who consented to switch from TIO/OLO to GLY/IND or UMEC/VI were followed-up thereafter. Results: In total, 53 patients completed the study (mean age, 75 years;48 males and 5 females;GOLD 1/2/3/4 = 19/27/6/1;mMRC 0/1/2/3/4 = 14/22/12/4/1;UMEC/VI 26, GLY/IND 27). PGR, mMRC, and CAT improved in 20 (38%), 9 (17%), and 15 patients (28%), respectively. Respiratory system resistance at 5 Hz (R5), 20 Hz (R20), and the difference between R5 and R20 (R5 - R20) significantly improved. In a follow-up of 16 patients after switching from TIO/OLO to UMEC/VI (9) or GLY/IND (7), PGR, mMRC, and CAT improved in 5 (31%), 3 (12%), and 4 patients (25%), respectively, and R20 significantly improved (p = 0.011). Conclusions: Switching dual bronchodilators between dry powder and soft mist inhalers improves symptoms and airway narrowing in some COPD patients.

The liver-to-spleen ratio is a risk factor predicting oxygen demand in COVID-19 patients

Background:We aimed to investigate risk factors predicting oxygen demand in COVID-19 patients.Methods:Patients admitted to Shizuoka General Hospital with COVID-19 from August 2020 to August 2021 were included.First,we divided patients into groups with and without oxygen demand.Then,we compared patients’clinical characteristics and laboratory and radiological findings to determine factors predicting oxygen demand.Results:One hundred seventy patients with COVID-19(aged 58±15 years,57 females)were enrolled.Common comorbidities were cardiovascular diseases(47.6%),diabetes mellitus(28.8%),and dyslipidemia(26.5%).Elder age,higher body mass index,cardiovascular diseases,diabetes mellitus,lower lymphocyte count,albumin,hep-atic attenuation value,and the liver-to-spleen ratio(L/S),higher D-dimer,aspartate aminotransferase,lactate dehydrogenase,troponin-T,C-reactive protein,KL-6,chest and abdominal circumference,and visceral fat were found in patients with oxygen demand.According to the multivariate logistic regression analysis,L/S,lympho-cyte count,D-dimer,and abdominal circumference under the diaphragm were independent risk factors predicting oxygen demand in COVID-19 patients.Conclusions:On admission,L/S,lymphocyte count,D-dimer,and abdominal circumference were predictive factors for oxygen demand.These factors may help in the appropriate triage of COVID-19 patients in the decision to admit them to the hospital.