Computed tomography (CT)-assessed bronchodilation induced by inhaled indacaterol and glycopyrronium/indacaterol in COPD. (October 2016)

• Record Type: Journal Article
• Authors: Shimizu, Kaoruko; Seto, Ruriko; Makita, Hironi; Suzuki, Masaru; Konno, Satoshi; Ito, Yoichi M.; Kanda, Rie; Ogawa, Emiko; Nakano, Yasutaka; Nishimura, Masaharu
• Is Part Of: Respiratory medicine. Volume 119(2016)
• Page Start: 70
• Page End: 77
• Publication Date: 2016-10
• Subjects: Bronchodilation -- β2 agonists -- Anticholinergics -- Pulmonary function tests -- Three-dimensional computed tomography; Ai airway inner luminal area -- BMI body mass index -- COPD chronic obstructive pulmonary disease -- CT computed tomography -- DLco diffusing capacity of the lung for carbon monoxide -- FEV1 forced expiratory volume in 1 s -- FRC functional residual capacity -- FVC forced vital capacity -- IC inspiratory capacity -- LABA long acting β2 agonist -- LAMA long acting muscarinic antagonist -- Pi10 the square root of the airway wall area at an internal perimeter of 10 mm -- RV residual volume -- SABA short acting β2 agonist -- SAMA short acting muscarinic antagonist -- SFC salmeterol/fluticasone combination inhaler -- TLC total lung capacity -- VA alveolar volume -- VC vital capacity -- 3D-CT three-dimensional CT; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2016.08.020
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Our previous studies suggested that the site of bronchodilation on CT might differ between inhaled β2 agonists and inhaled anticholinergics in COPD. Aim: To assess and compare the bronchodilation effects of inhaled indacaterol and glycopyrronium/indacaterol by airway generation in large airways using CT. Methods: CT scans at full inspiration and pulmonary function tests were done in 25 patients with moderate-severe COPD before and 4–5 weeks after daily inhalation of indacaterol and again another 4–5 weeks after inhalation of glycopyrronium/indacaterol. Airway inner luminal area (Ai) at the 3rd (segmental) to 6th generation of 8 selected bronchi, a total of 32 sites, in the right lung was analyzed on 3 occasions. Our proprietary software enables us to select the same airways and the same measurement sites for comparison, with simultaneous confirmation using two screens on the computer. Results: The overall increase of Ai (ΔAi, %) averaged at all 32 measurement sites induced by glycopyrronium/indacaterol had a significant correlation with FEV1 improvement (r = 0.7466, p < 0.0001). Both ΔAi, % with indacaterol and ΔAi, % with additional glycopyrronium were significant at the 3rd to 6th generations. Remarkable increases in ΔAi, % were found at the 5th and 6th generations in several subjects with indacaterol or additional glycopyrronium. There were no significant site-differences in the bronchodilation pattern caused by indacaterol and by glycopyrronium/indacaterol at any of the 3rd to 6th generations. Conclusions: Additional bronchodilation with glycopyrronium was demonstrated by CT at the 3rd to 6th generations, with no site-specific differences in bronchodilation between indacaterol and glycopyrronium/indacaterol. This study was registered in the UMIN Clinical Trials Registry (UMIN-CTR) system (http://www.umin.ac.jp/ . ID. UMIN000012043). Highlights: We compared CT-assessed bronchodilation fron 3rd to 6th generations between monotherapy and combination therapy in patients with COPD. Our 3D-CT software enables us to make direct comparison of airway inner luminal area at the same site before and after bronchodilation. We attempted to examined the novel hypothesis that bronchodilation pattern might differ between monotherapy and combination therapy by airway generations. Although the study did not prove the hypothesis, we could nevertheless provide further evidence of additional anatomical bronchodilation at 3rd to 6th generation by 3D-CT analysis in response to combination therapy.