title: Responses to inhaled long-acting beta-agonist and corticosteroid according to COPD subtype.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disorder in which a number of different pathological processes lead to recognition of patient subgroups that may have individual characteristics and distinct responses to treatment.
  
  
  OBJECTIVE
  We tested the hypothesis that responses of lung function to 3 months of combined inhalation of long-acting beta-agonist and corticosteroid might differ among patients with various COPD subtypes.
  
  
  METHODS
  We classified 165 COPD patients into four subtypes according to the severity of emphysema and airflow obstruction: emphysema-dominant, obstruction-dominant, mild-mixed, and severe-mixed. The emphysema-dominant subtype was defined by an emphysema index on computed tomography of more than 20% and FEV(1) more than 45% of the predicted value. The obstruction-dominant subtype had an emphysema index < or = 20% and FEV(1) < or = 45%, the mild-mixed subtype had an emphysema index < or = 20% and FEV(1) > 45%, and the severe-mixed subtype had an emphysema index > 20% and FEV(1) < or = 45%. Patients were recruited prospectively and treated with 3 months of combined inhalation of long-acting beta-agonist and corticosteroid.
  
  
  RESULTS
  After 3 months of combined inhalation of long-acting beta-agonist and corticosteroid, obstruction-dominant subtype patients showed a greater FEV(1) increase and more marked dyspnea improvement than did the emphysema-dominant subgroup. The mixed-subtype patients (both subgroups) also showed significant improvement in FEV(1) compared with the emphysema-dominant subgroup. Emphysema-dominant subtype patients showed no improvement in FEV(1) or dyspnea after the 3-month treatment period.
  
  
  CONCLUSIONS
  The responses to 3 months of combined inhalation of long-acting beta-agonist and corticosteroid differed according to COPD subtype.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, CHA University, Seongnam, South Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Lee
authors.forename: Eun-Kyung
authors.initials: EK
authors.lastname: Kim
authors.forename: Tae-Hyung
authors.initials: TH
authors.lastname: Kim
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Huh
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Kim
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Lee
authors.forename: Sang-Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Sangyeub
authors.initials: S
authors.lastname: Lee
authors.forename: Seong Yong
authors.initials: SY
authors.lastname: Lim
authors.forename: Tae Rim
authors.initials: TR
authors.lastname: Shin
authors.forename: Ho Il
authors.initials: HI
authors.lastname: Yoon
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Sheen
authors.forename: Namkug
authors.initials: N
authors.lastname: Kim
authors.forename: Joon Beom
authors.initials: JB
authors.lastname: Seo
authors.forename: Yeon-Mok
authors.initials: YM
authors.lastname: Oh
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000704:Analysis of Variance; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004417:Dyspnea / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007723:Korea; D008297:Male; D010349:Patient Compliance; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D018343:Receptors, Adrenergic, beta-2 / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013147:Spirometry; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D018343:Receptors, Adrenergic, beta-2