title: Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD.
abstract: BACKGROUND
  The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting β2-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice.
  
  
  METHODS
  Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39). The index time was defined as the time of withdrawal in the stepdown group and as 1 year after the start of triple therapy in the triple group.
  
  
  RESULTS
  Lung function at the index time was superior and the previous exacerbation frequency was lower in the stepdown group than in the triple group. Step-down resulted in aggravating disease symptoms, a reduced overall quality of life, decreasing exercise performance, and accelerated forced expiratory volume in 1 second (FEV1) decline (54.7±15.7 mL/yr vs. 10.7±7.1 mL/yr, p=0.007), but there was no observed increase in the frequency of exacerbations.
  
  
  CONCLUSIONS
  Withdrawal of a single inhaler during triple therapy in COPD patients should be conducted with caution as it may impair the exercise capacity and quality of life while accelerating FEV1 decline.
authors.affiliation: Department of Internal Medicinem, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Sae Ahm
authors.initials: SA
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Eun-Kyung
authors.initials: EK
authors.lastname: Kim
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
authors.forename: Tae-Hyung
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Ewha Womens University Mokdong Hospital, Ewha Womens University School of Medicine, Seoul, Korea.
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Ho Il
authors.initials: HI
authors.lastname: Yoon
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seunghee
authors.initials: S
authors.lastname: Baek
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asthma Center, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asthma Center, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Yeon-Mok
authors.initials: YM
authors.lastname: Oh
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asthma Center, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang-Do
authors.initials: SD
authors.lastname: Lee
keywords: Chronic Obstructive; Pulmonary Disease