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Wu F, Dai C, Zhou Y, Deng Z, Wang Z, Li X, Chen S, Guan W, Zhong N, Ran P. Tiotropium reduces clinically important deterioration in patients with mild-to-moderate chronic obstructive pulmonary disease: A post hoc analysis of the Tie-COPD study. Respir Med 2024; 222:107527. [PMID: 38199288 DOI: 10.1016/j.rmed.2024.107527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Clinically important deterioration (CID) is a composite endpoint used to holistically assess the complex progression of chronic obstructive pulmonary disease (COPD). Tiotropium improves lung function and reduces the rate of COPD exacerbations in patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 (mild) or 2 (moderate). However, whether tiotropium reduces CID risk in patients with mild-to-moderate COPD remains unclear. METHODS This was a post hoc analysis of the 24-month Tie-COPD study comparing 18 μg tiotropium with placebo in patients with mild-to-moderate COPD. CID was defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 s, an increase of ≥2 unit in COPD Assessment Test (CAT) score, or moderate-to-severe exacerbation. The time to the first occurrence of one of these events was recorded as the time to the first CID. Subgroup analyses were conducted among patients stratified by CAT score, modified Medical Research Council (mMRC) dyspnea score, and GOLD stage at baseline. RESULTS Of the 841 randomized patients, 771 were included in the full analysis set. Overall, 643 patients (83.4 %) experienced at least one CID event. Tiotropium significantly reduced the CID risk and delayed the time to first CID compared with placebo (adjusted hazard ratio = 0.58, 95 % confidence interval = 0.49-0.68, P < 0.001). Significant reductions in CID risk were also observed in various subgroups, including patients with a CAT score <10, mMRC score <2, and mild COPD. CONCLUSIONS Tiotropium reduced CID risk in patients with mild-to-moderate COPD, even in patients with fewer respiratory symptoms or mild disease, which highlights tiotropium's effectiveness in treating COPD patients with mild disease. TRIAL REGISTRATION This study is registered at ClinicalTrials.gov (Tie-COPD, NCT01455129).
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Affiliation(s)
- Fan Wu
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China
| | - Cuiqiong Dai
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yumin Zhou
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China
| | - Zhishan Deng
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zihui Wang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaochen Li
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuyun Chen
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weijie Guan
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China.
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Koenigsberg R, Stukus D. Intermittent Tiotropium Bromide for Episodic Wheezing: A Randomized Trial. Pediatrics 2023; 152:S53. [PMID: 38038496 DOI: 10.1542/peds.2023-064344nb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
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Hanania NA, Settipane RA, Khoury S, Shaikh A, Dotiwala Z, Casciano J, Foggs MB. Adding tiotropium or long-acting β2-agonists to inhaled corticosteroids: Asthma-related exacerbation risk and healthcare resource utilization. Allergy Asthma Proc 2023; 44:413-421. [PMID: 37919843 DOI: 10.2500/aap.2023.44.230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Background: Based on current clinical guidelines, long-acting β2-agonists (LABA) are frequently prescribed before long-acting muscarinic antagonists (LAMA) as an add-on to inhaled corticosteroids (ICS) in uncontrolled asthma. However, there is insufficient real-world evidence that supports this therapeutic approach. Objective: The objective was to compare asthma exacerbations and healthcare resource utilization in patients with asthma using the LAMA tiotropium bromide (Tio) or a LABA as an add-on to ICS (ICS + Tio or ICS/LABA) in a real-world setting. Methods: This retrospective, observational study included patients aged ≥12 years with asthma diagnoses identified in a U.S. longitudinal claims database (October 2015 to August 2020). The ICS + Tio and ICS/LABA cohorts were 1:2 propensity score matched for baseline variables. Outcomes were compared in the postmatched cohorts, and the risk of exacerbation was evaluated by using Kaplan-Meier curves. Results: After propensity score matching, there were 633 and 1266 patients in the ICS + Tio and ICS/LABA cohorts, respectively. The proportion of patients who experienced a severe or a moderate-or-severe exacerbation during follow-up was similar between the ICS + Tio versus ICS/LABA cohorts (4% versus 3%, p = 0.472, and 50% versus 45%, p = 0.050, respectively). The mean time to first severe (ICS + Tio 43.8 days versus ICS/LABA 49.4 days, p = 0.758) and moderate-or-severe exacerbation (ICS + Tio 65.8 days versus ICS/LABA 58.9 days, p = 0.474) was not statistically different between cohorts. The treatments had no effect on the risk of severe exacerbation, although it was 36% lower in ICS + Tio users than in ICS/LABA users (hazard ratio 0.64 [95% confidence interval, 0.22-1.84]). All-cause and asthma-related average monthly healthcare resource utilization were comparable between the treatments for hospitalizations and emergency department visits but were significantly greater in the ICS + Tio cohort than in the ICS/LABA cohort for asthma-related outpatient visits (p < 0.0001). Conclusion: This study provides real-world evidence that ICS + Tio may be a valid alternative when ICS/LABA cannot be used as first-line treatment for asthma maintenance therapy.
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Affiliation(s)
- Nicola A Hanania
- From the Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas
| | - Russell A Settipane
- Allergy and Asthma Center and Alpert Medical School of Brown University, East Providence, Rhode Island
| | - Samir Khoury
- Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Asif Shaikh
- Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | | | | | - Michael B Foggs
- Division of Allergy and Immunology, Advocate Health Care, Chicago, Illinois
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Lim JU, Park S, Yoon JH, Lee SE, Cho BS, Kim YJ, Lee S, Kim HJ, Rhee CK. Efficacy of inhaled tiotropium add-on to budesonide/formoterol in patients with bronchiolitis obliterans developing after hematopoietic stem cell transplantation. Respir Med 2023; 218:107410. [PMID: 37696312 DOI: 10.1016/j.rmed.2023.107410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Bronchiolitis obliterans syndrome (BOS) is the lung manifestation of chronic graft-versus-host disease after hematopoietic stem cell transplantation (HSCT). We assessed whether inhaled tiotropium add-on to the combination regimen including budesonide/formoterol improve pulmonary function and the chronic obstructive pulmonary disease assessment test (CAT) scores in patients with BOS. METHODS Post-HSCT patients diagnosed as BOS in Seoul St. Mary's Hospital were reviewed retrospectively. Patients defined as BOS and treated with budesonide/formoterol/tiotropium combination therapy after budesonide/formoterol therapy from January 2011 to June 2019 were enrolled. RESULTS Total of 86 patients were evaluated. After tiotropium add-on, the absolute FEV1 increased significantly from 1.47 ± 0.49 to 1.53 ± 0.57 L (p = 0.023) and the % predicted FEV1 from 45.0 ± 12.8 to 46.8 ± 14.5% (p = 0.031). The % predicted DLCO increased significantly after tiotropium add-on (from 61.6 ± 16.7 to 64.3 ± 16.3%, p = 0.028). Among 56 patients with complete CAT scores, no significant change was present in total CAT scores. In all, 30 of the 72 patients (41.7%) evidenced FEV1 increases > 100 mL, and 20 of 56 patients (35.7%) had CAT score decreases of ≥ 2 points. When the FEV1 and CAT scores were combined, the overall response rate to tiotropium add-on was 56.2% (41/73). The response group evidenced a significantly greater FVC increase, and a significant decrease in the RV/TLC ratio compared to the no-response group. CONCLUSIONS Inhaled tiotropium add-on to combination budesonide/formoterol significantly improved lung function, but not respiratory symptoms, in patients with post-HSCT BOS.
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Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Silvia Park
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae-Ho Yoon
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Eun Lee
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung-Sik Cho
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yoo-Jin Kim
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seok Lee
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hee-Je Kim
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Buigues P, Gehrke S, Badaoui M, Dudas B, Mandana G, Qi T, Bottegoni G, Rosta E. Investigating the Unbinding of Muscarinic Antagonists from the Muscarinic 3 Receptor. J Chem Theory Comput 2023; 19:5260-5272. [PMID: 37458730 PMCID: PMC10413856 DOI: 10.1021/acs.jctc.3c00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Indexed: 08/09/2023]
Abstract
Patient symptom relief is often heavily influenced by the residence time of the inhibitor-target complex. For the human muscarinic receptor 3 (hMR3), tiotropium is a long-acting bronchodilator used in conditions such as asthma or chronic obstructive pulmonary disease (COPD). The mechanistic insights into this inhibitor remain unclear; specifically, the elucidation of the main factors determining the unbinding rates could help develop the next generation of antimuscarinic agents. Using our novel unbinding algorithm, we were able to investigate ligand dissociation from hMR3. The unbinding paths of tiotropium and two of its analogues, N-methylscopolamin and homatropine methylbromide, show a consistent qualitative mechanism and allow us to identify the structural bottleneck of the process. Furthermore, our machine learning-based analysis identified key roles of the ECL2/TM5 junction involved in the transition state. Additionally, our results point to relevant changes at the intracellular end of the TM6 helix leading to the ICL3 kinase domain, highlighting the closest residue L482. This residue is located right between two main protein binding sites involved in signal transduction for hMR3's activation and regulation. We also highlight key pharmacophores of tiotropium that play determining roles in the unbinding kinetics and could aid toward drug design and lead optimization.
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Affiliation(s)
- Pedro
J. Buigues
- Department
of Physics and Astronomy, University College
London, London WC1E 6BT, United
Kingdom
| | - Sascha Gehrke
- Department
of Physics and Astronomy, University College
London, London WC1E 6BT, United
Kingdom
| | - Magd Badaoui
- Department
of Physics and Astronomy, University College
London, London WC1E 6BT, United
Kingdom
| | - Balint Dudas
- Department
of Physics and Astronomy, University College
London, London WC1E 6BT, United
Kingdom
| | - Gaurav Mandana
- Department
of Physics and Astronomy, University College
London, London WC1E 6BT, United
Kingdom
| | - Tianyun Qi
- Department
of Physics and Astronomy, University College
London, London WC1E 6BT, United
Kingdom
| | - Giovanni Bottegoni
- Dipartimento
di Scienze Biomolecolari (DISB), University
of Urbino, Urbino Piazza Rinascimento, 6, Urbino 61029, Italy
- Institute
of Clinical Sciences, University of Birmingham, Edgbaston, B15 2TT Birmingham, United Kingdom
| | - Edina Rosta
- Department
of Physics and Astronomy, University College
London, London WC1E 6BT, United
Kingdom
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Affiliation(s)
- Adrian Gillissen
- Medizinische Klinik III, Klinikum am Steinenberg, Stuttgarter Str. 100, 72574, Reutlingen/Bad Urach, Deutschland
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Wang L, Shi YH, Yang H, Xu JF. [Annual review of bronchiectasis in 2021]. Zhonghua Jie He He Hu Xi Za Zhi 2022; 45:592-597. [PMID: 35658383 DOI: 10.3760/cma.j.cn112147-20220111-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Bronchiectasis, a common chronic respiratory disease, is characterized by irreversible and abnormal bronchial dilatation due to multiple causes. In 2021, a series of significant research progress have been made in bronchiectasis, focusing on the mechanism, diagnosis, clinical phenotypes, treatment, comorbidities, etc. Several studies have shown that many mediators are involved in the pathogenesis of bronchiectasis, such as lipids, platelets, and respiratory microorganisms, providing new insights into the development of prevention and therapy targets of bronchiectasis. At the same time, an international expert consensus proposed radiological and clinical diagnosis criteria for inclusion of bronchiectasis patients in clinical trials. Moreover, the proposal of new phenotype, measurement tools and predictors on bronchiectasis, promote the process of individualized therapy for patients. Regarding the clinical trials on bronchiectasis, several important studies have been published, including tobramycin inhalation powder, airway clearance techniques, tiotropium bromide and so forth. In addition, researches on bronchiectasis comorbidities also have new findings. This review summarized the recent published literatures in order to help clinicians better understand bronchiectasis.
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Affiliation(s)
- L Wang
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Y H Shi
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - H Yang
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - J F Xu
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
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Webber EM, Lin JS, Thomas RG. Screening for Chronic Obstructive Pulmonary Disease: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 327:1812-1816. [PMID: 35536261 DOI: 10.1001/jama.2022.4708] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the US. OBJECTIVE To conduct a targeted systematic review to update the evidence on the effectiveness of screening for COPD and the treatment of COPD to inform the US Preventive Services Task Force (USPSTF) update of the 2016 recommendation statement on COPD screening. DATA SOURCES MEDLINE, the Cochrane Central Register of Controlled Trials, and CINAHL for relevant studies published between January 1, 2015, to January 22, 2021; surveillance through March 25, 2022. STUDY SELECTION English-language studies of screening in individuals who do not recognize or report respiratory symptoms; studies of treatment in persons with mild or moderate, or minimally symptomatic, COPD. DATA EXTRACTION AND SYNTHESIS Two reviewers independently appraised the articles and extracted relevant data from fair- or good-quality studies; no quantitative synthesis was conducted. MAIN OUTCOMES AND MEASURES COPD-related morbidity or mortality, measures of health-related quality of life, and adverse events. RESULTS The review included no trials on the effectiveness of screening, 3 trials or analyses (n = 20 058) of pharmacologic treatment published since 2015, 13 trials (n = 3657) on nonpharmacologic interventions, and 2 large observational studies (n = 243 517) addressing the harms of pharmacologic treatment published since 2015. The results from the clinical trials of pharmacologic therapy are consistent with the previous review supporting the USPSTF that bronchodilators with or without inhaled corticosteroids can reduce COPD exacerbations and tiotropium can improve health-related quality of life in adults with moderate COPD. Overall, there was no consistent benefit observed for any type of nonpharmacologic intervention across a range of patient outcomes. None of the included treatment trials that reported adverse effects found significant harms. Two large observational studies in a screen-relevant population demonstrated an association of the initiation of a long-acting muscarinic antagonist or long-acting beta agonist with the risk of a serious cardiovascular event in treatment-naïve patients and an association of inhaled corticosteroids use with the risk of developing diabetes. CONCLUSIONS AND RELEVANCE The findings of this targeted evidence update are generally consistent with the findings of the previous systematic review supporting the 2016 USPSTF recommendation. Evidence of pharmacologic treatment was still largely limited to persons with moderate airflow obstruction, and there was no consistent benefit observed for a range of nonpharmacologic interventions in mild to moderate COPD or in minimally symptomatic persons with COPD.
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Affiliation(s)
- Elizabeth M Webber
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Rachel G Thomas
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Suzuki Y, Sato S, Sato K, Inoue S, Shibata Y. Treatment efficacy of LAMA versus placebo for stable chronic obstructive pulmonary disease: A systematic review and meta-analysis. Respir Investig 2022; 60:108-118. [PMID: 34489206 DOI: 10.1016/j.resinv.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Four long-acting muscarinic antagonists (LAMAs), tiotropium, glycopyrronium, aclidinium, and umeclidinium, are currently available for the treatment of stable chronic obstructive pulmonary disease (COPD). However, no integrated analysis has sought to determine the effectiveness of these LAMAs. Thus, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of LAMA versus placebo in patients with stable COPD. METHODS A literature search of relevant randomized control trials that administered LAMA to stable COPD patients was conducted, and the exacerbations, quality of life (QoL), dyspnea score, lung function, and adverse event of patients were evaluated. RESULTS A total of 33 studies were included in this meta-analysis. LAMA significantly decreased the frequency of exacerbations compared to the placebo (OR 0.75; 95% CI 0.66 to 0.85; P < 0.001). The mean changes in the St George's Respiratory Questionnaire score (mean difference, -3.61; 95% CI, -4.27 to -2.95; P < 0.00001), transitional dyspnea index score (mean difference 1.00; 95% CI 0.83 to 1.17; P < 0.00001), and trough FEV1 (mean difference 0.12; 95% CI 0.11 to 0.13; P < 0.0001) indicated significantly greater improvement in the LAMA group than the placebo group. The number of withdrawals due to adverse events in the LAMA group was significantly fewer than that in the placebo group (OR -0.02; 95% CI -0.03 to -0.01; P = 0.002). CONCLUSION LAMA is superior to placebo due to lower frequency of exacerbations and adverse events, as well as higher trough FEV1, QoL, and dyspnea score for stable COPD.
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Affiliation(s)
- Yasuhito Suzuki
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.
| | - Suguru Sato
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.
| | - Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan.
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan.
| | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.
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Peters SP. NHLBI ASTHMA NETWORKS: IMPROVING PATIENT CARE, MOVING TOWARD PERSONALIZED MEDICINE. Trans Am Clin Climatol Assoc 2022; 132:44-60. [PMID: 36196171 PMCID: PMC9480564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The first NHLBI Clinical Trials Research Network was the Asthma Clinical Research Network (ACRN 1), which was born in 1993 to perform multiple controlled clinical trials for asthma: "… dispassionately examine new & existing therapies for asthma" and "… rapidly communicate findings to medical community," and therefore, to perform clinical trials drug companies could not or would not do. Among the many areas studied by the ACRN and its successor networks, through 2019, was how to effectively and safely use long-acting beta-agonists and to find novel alternatives for them. In its Tiotropium Add-On Trial (TALC) trial, the ACRN demonstrated that tiotropium as add on-therapy to inhaled corticosteroids (ICS) was effective and non-inferior to long-acting beta-agonist add on-therapy. During the lifetime of the clinical trial networks (1993-2020), 71 manuscripts including 25 major clinical trials were published, many which have laid the groundwork for precision approaches for asthma therapy and the now ongoing PrecISE Asthma Network.
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Momo N, Doi K, Tanaka Y. [SEVERE INFANTILE ASTHMA TREATED WITH LONG-ACTING MUSCARINIC ANTAGONIST: A CASE SERIES]. Arerugi 2022; 71:248-253. [PMID: 35569947 DOI: 10.15036/arerugi.71.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Long-acting muscarinic antagonists (LAMA) are used for long-term treatment of bronchial asthma in adults. Its use in the management of pediatric bronchial asthma, however, is currently not approved in Japan. Nonetheless, there have been a few reports of its use in children, particularly in cases of severe bronchial asthma or those without atopic disease that are refractory to existing treatment protocols. We report the progress of LAMA in infantile asthma patients. CASES Three out of four patients had LAMA introduced at 3 to 5 years of age after being diagnosed with asthma at 1 to 3 years old. Three patients had non-IgE-related asthma and an underlying disease, such as Apert and Noonan syndrome, while one patient had severe IgE-related asthma without a pre-existing disease. In all cases, conventional long-term medications such as medium to high-dose inhaled corticosteroids and long-acting beta-agonists, were given. However, severe bronchial asthma persisted, with some patients having uncontrolled secretions. Since uncontrolled severe-persistent bronchial asthma results in repeated hospitalization and intensive care unit admission, we introduced LAMA, specifically 2.5μg/day of tiotropium (Tio). After the introducing Tio, none of the patients had an acute exacerbation that required hospitalization and the frequency of wheezing was reduced. LAMA was administered for up to 19 months, with no adverse events. CONCLUSION The results of this series suggest that LAMA is an effective and safe option for uncontrolled infantile asthma.
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Affiliation(s)
| | - Kei Doi
- Department of Allergy, Kobe Children's Hospital
| | - Yuya Tanaka
- Department of Allergy, Kobe Children's Hospital
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Ostrovskyy MM, Kulynych-Miskiv MO, Volnytska KI, Todoriko LD, Ostrovska KM, Varunkiv OI, Savelikhina IO. NEW POSSIBILITIES FOR MODIFYING THE COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: THE EFFECT OF TIOTROPIUM BROMIDE ON CERTAIN PATHOGENETIC LINKS OF NEOCOLLAGENOGENESIS AND LOCAL IMMUNE DEFENCE OF THE BRONCHIAL TREE. Wiad Lek 2022; 75:473-477. [PMID: 35307679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim: To evaluate the dynamics of the interferon and collagen-IV systems in bronchoalveolar lavage in the treatment of chronic obstructive pulmonary disease using the tiotropium bromide medication. PATIENTS AND METHODS Materials and methods: The study involved 60 COPD patients with bronchial obstruction of the II degree before and on days 30 and 60 of therapy using conventional treatment regimens and inhalations of tiotropium bromide a the dose of 18 mcg once a day. The collagen-IV levels in bronchoalveolar fluid were determined by means of enzyme-linked immunoassay using "StatFax 303 Plus" analyzer and "Biotrin Collagen IV EIA" reagents. The level of IFN-γ was identified with the help of enzyme-linked immunoassay using "StatFax 303 Plus" analyzer and "ProKon" reagents (LLC "Protein Contour", Russia) in bronchoalveolar fluid obtained during fiber-optic bronchoscopy. RESULTS Results: When examining Group I patients on the 30th day we found out that the content of collagen-IV in the bronchoalveolar fluid had decreased by only 10.29% (p <0.05). Detection of collagen-IV indices in Group II patients on the 30th day of tiotropium bromide use showed the 29.43% (p <0.05) decrease in its content as compared to the initial indices. In Group III patients, the concentration of collagen-IV had a maximum tendency to normalize and made up (24.72 ± 1.15) ng/ml, and decreased by 2.44 times (p <0.05) as compared to the initial indices. Our examination of 12 patients from the comparison group I on the 60th day of treatment revealed even a slight increase in the content of collagen-IV in the bronchoalveolar fluid, as compared with the data obtained on the 30th day. The identified IFN-γ deficiency is indicative for the COPD of the II degree of bronchial obstruction, and its indices were 2.29 times lower than those observed in people from the control group. On day 30, we found out that the content of IFN-γ in Group I patients increased by only 10.29% (p>0.05). Detection of IFN-γ in Group II patients showed 42.27% (p<0,05) increase in its content as compared to the initial indices. The most favorable dynamics of IFN-γ levels in bronchoalveolar contents was observed in Group III patients, and at the time of observation it made up (1.16 ± 0.08) pg/ml, having 2 times (p<0.05) increased as compared to the initial indices. However, in contrast to those taking tiotropium bromide, we examined 12 patients from Group I on the 60th day of treatment and found no significant positive dynamics of IFN-γ content in bronchoalveolar fluid as compared to the indices obtained on day 30. CONCLUSION Conclusions: The obtained findings indicate the effect of tiotropium bromide on the reduction of interferon-γ and reduce of collagen-IV levels, which depend on the duration of its use.
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Yu S, Zhang C, Yan Z, Fang Q, Gao X. Tiotropium Bromide Attenuates Mucus Hypersecretion in Patients with Stable Chronic Obstructive Pulmonary Disease. Comput Math Methods Med 2021; 2021:1341644. [PMID: 34650619 PMCID: PMC8510842 DOI: 10.1155/2021/1341644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with stable chronic obstructive pulmonary disease (COPD) have been observed to benefit from tiotropium bromide. However, there are few studies of tiotropium bromide on sputum and sputum viscosity. To evaluate the effect of tiotropium bromide on mucus hypersecretion, a randomized, double-blind controlled trial was performed. METHODS 120 cases of patients with pulmonary function grade II were divided into two groups, which include the treatment group given tiotropium bromide powder inhalation (18 μg, inhalation, QD) and the control group given formoterol fumarate powder inhalation (12 μg, inhalation, BID) plus ambroxol hydrochloride tablets (60 mg, oral, TID). After 3 months of treatment, the pulmonary function and α 1-acid glycoprotein (α 1-AGP) in sputum were detected, and the changes of glycoprotein and Ca2+ content were evaluated by Miller classification. RESULTS Three patients (2 cases in the treatment group and 1 case in the control group) were dropped due to loss of follow-up, and 117 cases of patients were enrolled in this study. After 3 months of treatment, the sputum character score, α1-acid glycoprotein, Ca2+ content, and lung function of the two groups were significantly improved; group comparison analyses revealed that there was no significant difference in the content of α 1-AGP, Ca2+ in sputum, and lung function between the two groups (P > 0.05), but the improvement of sputum properties was significant (P < 0.05), and the treatment group was better than the control group (t = -2.77; P = 0.007). CONCLUSIONS Inhaled tiotropium bromide can effectively inhibit the mucus hypersecretion in stable COPD patients, improve the sputum properties and lung function of patients, and improve the quality of life of patients.
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Affiliation(s)
- Suyun Yu
- Department of Respiratory Medicine, Minhang Hospital Affiliated to Fudan University, Minhang District Central Hospital, Shanghai 201199, China
| | - Caili Zhang
- Minhang Qibao Community Health Service Center, Shanghai 201108, China
| | - Zhijun Yan
- Department of Respiratory Medicine, Minhang Hospital Affiliated to Fudan University, Minhang District Central Hospital, Shanghai 201199, China
| | - Qingqing Fang
- Department of Gastroenterology, Minhang Hospital Affiliated to Fudan University, Minhang District Central Hospital, Shanghai 201199, China
| | - Xiwen Gao
- Department of Respiratory Medicine, Minhang Hospital Affiliated to Fudan University, Minhang District Central Hospital, Shanghai 201199, China
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Hoogendoorn M, Corro Ramos I, Soulard S, Cook J, Soini E, Paulsson E, Rutten-van Mölken M. Cost-effectiveness of the fixed-dose combination tiotropium/olodaterol versus tiotropium monotherapy or a fixed-dose combination of long-acting β2-agonist/inhaled corticosteroid for COPD in Finland, Sweden and the Netherlands: a model-based study. BMJ Open 2021; 11:e049675. [PMID: 34348953 PMCID: PMC8340281 DOI: 10.1136/bmjopen-2021-049675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) guidelines advocate treatment with combinations of long-acting bronchodilators for patients with COPD who have persistent symptoms or continue to have exacerbations while using a single bronchodilator. This study assessed the cost-utility of the fixed dose combination of the bronchodilators tiotropium and olodaterol versus two comparators, tiotropium monotherapy and long-acting β2 agonist/inhaled corticosteroid (LABA/ICS) combinations, in three European countries: Finland, Sweden and the Netherlands. METHODS A previously published COPD patient-level discrete event simulation model was updated with most recent evidence to estimate lifetime quality-adjusted life years (QALYs) and costs for COPD patients receiving either tiotropium/olodaterol, tiotropium monotherapy or LABA/ICS. Treatment efficacy covered impact on trough forced expiratory volume in 1 s (FEV1), total and severe exacerbations and pneumonias. The unit costs of medication, maintenance treatment, exacerbations and pneumonias were obtained for each country. The country-specific analyses adhered to the Finnish, Swedish and Dutch pharmacoeconomic guidelines, respectively. RESULTS Treatment with tiotropium/olodaterol gained QALYs ranging from 0.09 (Finland and Sweden) to 0.11 (the Netherlands) versus tiotropium and 0.23 (Finland and Sweden) to 0.28 (the Netherlands) versus LABA/ICS. The Finnish payer's incremental cost-effectiveness ratio (ICER) of tiotropium/olodaterol was €11 000/QALY versus tiotropium and dominant versus LABA/ICS. The Swedish ICERs were €6200/QALY and dominant, respectively (societal perspective). The Dutch ICERs were €14 400 and €9200, respectively (societal perspective). The probability that tiotropium/olodaterol was cost-effective compared with tiotropium at the country-specific (unofficial) threshold values for the maximum willingness to pay for a QALY was 84% for Finland, 98% for Sweden and 99% for the Netherlands. Compared with LABA/ICS, this probability was 100% for all three countries. CONCLUSIONS Based on the simulations, tiotropium/olodaterol is a cost-effective treatment option versus tiotropium or LABA/ICS in all three countries. In both Finland and Sweden, tiotropium/olodaterol is more effective and cost saving (ie, dominant) in comparison with LABA/ICS.
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Affiliation(s)
- Martine Hoogendoorn
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Isaac Corro Ramos
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Stéphane Soulard
- Boehringer Ingelheim The Netherlands, Amsterdam, The Netherlands
| | - Jennifer Cook
- Boehringer Ingelheim International GmbH, Ingelheim, Rheinland-Pfalz, Germany
| | | | | | - Maureen Rutten-van Mölken
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
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Ferguson GT, Kerwin EM, Rheault T, Bengtsson T, Rickard K. A Dose-Ranging Study of the Novel Inhaled Dual PDE 3 and 4 Inhibitor Ensifentrine in Patients with COPD Receiving Maintenance Tiotropium Therapy. Int J Chron Obstruct Pulmon Dis 2021; 16:1137-1148. [PMID: 33911859 PMCID: PMC8075181 DOI: 10.2147/copd.s307160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/08/2021] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Ensifentrine is an inhaled dual inhibitor of phosphodiesterase (PDE) 3 and 4 that has shown bronchodilatory effects and symptom improvement in clinical studies in patients with chronic obstructive pulmonary disease (COPD), and anti-inflammatory effects in healthy volunteers in a model of COPD-like inflammation. This manuscript reports on the results of the clinical study examining if ensifentrine provides meaningful improvements in lung function when added on to tiotropium over 4 weeks in patients with COPD who have impaired lung function and symptoms despite treatment with tiotropium. PATIENTS AND METHODS This randomized, double-blind, placebo-controlled, parallel-group, dose-ranging study recruited patients with moderate-to-severe COPD. Patients were randomized to open-label tiotropium once daily (QD) plus (+) blinded escalating doses of ensifentrine or placebo twice daily (BID). Effects on lung function, symptoms and quality of life (QoL) were assessed over 4 weeks. RESULTS A total of 416 COPD patients were randomized and 413 received at least one dose of blinded study medication + tiotropium. All ensifentrine doses produced a significant and dose-dependent increase in peak forced expiratory volume in 1 second (FEV1) from baseline to Week 4, with placebo-corrected differences of 77.5 mL when added to tiotropium (0.375 mg; 95% CI: 4.8, 150.1 mL; p=0.037) to 124.2 mL (3 mg; 95% CI: 51.0, 196.8 mL; p<0.001). A significant increase in average FEV1 (0-12h) was shown at Week 4 with the 3 mg dose (87.3 mL; 95% CI: 20.0, 154.5 mL; p=0.011). Clinically meaningful and statistically significant improvements in the St. George's Respiratory Questionnaire - COPD (SGRQ-C) additive to tiotropium were observed at Week 4, exceeding the minimally clinically important difference of 4 units with the 1.5 and 3 mg doses. Adverse events were similar in frequency between the ensifentrine and placebo arms. CONCLUSION This clinical study demonstrated that nebulized ensifentrine added on to tiotropium produced clinically important improvements in lung function and QoL over 4 weeks in COPD patients receiving tiotropium who demonstrated symptoms and lung function impairment, with a safety profile similar to placebo.
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Affiliation(s)
- Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
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Chapman KR. Anticholinergic Bronchodilator Therapy of Asthma-Ageless. J Allergy Clin Immunol Pract 2021; 8:2661-2662. [PMID: 32888532 DOI: 10.1016/j.jaip.2020.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Kenneth R Chapman
- Department of Medicine, Division of Respiratory Medicine, University of Toronto, Toronto, Ontario, Canada; Asthma and Airway Centre, University Health Network, Toronto, Ontario, Canada.
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Wedzicha JA, Buhl R, Singh D, Vogelmeier CF, de la Hoz A, Xue W, Anzueto A, Calverley PMA. Tiotropium/Olodaterol Decreases Exacerbation Rates Compared with Tiotropium in a Range of Patients with COPD: Pooled Analysis of the TONADO ®/DYNAGITO ® Trials. Adv Ther 2020; 37:4266-4279. [PMID: 32776202 DOI: 10.1007/s12325-020-01438-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Previous studies demonstrated that tiotropium/olodaterol reduced rates of exacerbations in patients with chronic obstructive pulmonary disease (COPD). However, this should be examined in a wider population. METHODS This post hoc analysis pooled data from TONADO® 1 + 2 and DYNAGITO®, three 52-week, parallel-group, randomised, double-blind, phase III trials investigating patients with moderate-to-very severe COPD, with and without previous exacerbations, who received tiotropium/olodaterol 5/5 µg or tiotropium 5 µg. Subgroup analyses were conducted on patients stratified by exacerbation history, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2-4 disease severity and baseline inhaled corticosteroid (ICS) use. RESULTS In 9942 patients, tiotropium/olodaterol was associated with lower rates of moderate/severe exacerbations (0.68 vs. 0.77 per patient-year; rate ratio (RR) vs. tiotropium 0.89, 95% confidence interval (CI) 0.84, 0.95; P = 0.0003) and exacerbations requiring hospitalisation (0.11 vs. 0.13 per patient-year; RR 0.86, 95% CI 0.75, 0.99; P = 0.0380) versus tiotropium. Lower rates of moderate/severe exacerbations with tiotropium/olodaterol versus tiotropium were evident in patients with 0-1 moderate exacerbation in the previous year (0.54 vs. 0.60 per patient-year; RR 0.90, 95% CI 0.82, 0.98; P = 0.0187) and at least two moderate or at least one severe exacerbation(s) in the previous year (0.97 vs. 1.09 per patient-year; RR 0.89, 95% CI 0.82, 0.97; P = 0.0096). In patients with GOLD 2 and GOLD 3 COPD, moderate/severe exacerbation rates were lower with tiotropium/olodaterol versus tiotropium; GOLD 4 patients showed negligible difference between treatments. When evaluating patients by baseline ICS use, there was a significantly lower rate of moderate/severe exacerbations with tiotropium/olodaterol versus tiotropium in patients receiving ICS. CONCLUSIONS Tiotropium/olodaterol decreased the rate of moderate/severe exacerbations and exacerbations leading to hospitalisation versus tiotropium. Results from this large, pooled, post hoc analysis support the use of dual bronchodilation with tiotropium/olodaterol in a broad range of patients, reflective of patients with COPD in clinical practice. TRIAL REGISTRATION TONADO® 1 (ClinicalTrials.gov: NCT01431274); TONADO® 2 (ClinicalTrials.gov: NCT01431287); DYNAGITO® (ClinicalTrials.gov: NCT02296138). People with chronic obstructive pulmonary disease (COPD) may have times when their symptoms worsen, known as exacerbations. This may mean that they need to take additional medications, such as antibiotics or oral steroids. Studies have shown that a combination of two types of inhaled medicine-tiotropium and olodaterol-can help to reduce exacerbations in some people. To see if this is also the case across a larger and more diverse range of people, we combined the results from three studies (TONADO® 1 + 2 and DYNAGITO®) that looked at people who were taking tiotropium and olodaterol together and people who were taking tiotropium alone. We showed that, across a wide range of people, treatment with tiotropium/olodaterol was generally better at reducing exacerbations than tiotropium. Tiotropium/olodaterol also decreased the number of exacerbations that led to hospitalisation compared with tiotropium. Overall, our results support the use of combined tiotropium/olodaterol in people at different stages of COPD.
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Affiliation(s)
- Jadwiga A Wedzicha
- Respiratory Division, National Heart and Lung Institute, Imperial College London, London, UK.
| | - Roland Buhl
- Johannes Gutenberg University Mainz, Mainz, Germany
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Alberto de la Hoz
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Wenqiong Xue
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Antonio Anzueto
- Department of Pulmonary Medicine and Critical Care, University of Texas Health Sciences Center and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Peter M A Calverley
- Clinical Science Centre, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Buhl R, de la Hoz A, Xue W, Singh D, Ferguson GT. Efficacy of Tiotropium/Olodaterol Compared with Tiotropium as a First-Line Maintenance Treatment in Patients with COPD Who Are Naïve to LAMA, LABA and ICS: Pooled Analysis of Four Clinical Trials. Adv Ther 2020; 37:4175-4189. [PMID: 32671684 DOI: 10.1007/s12325-020-01411-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The efficacy of tiotropium/olodaterol compared with tiotropium in patients with chronic obstructive pulmonary disease (COPD) has been demonstrated in a large clinical programme. Currently, randomised controlled trial (RCT) data on dual bronchodilation as first-line maintenance therapy are limited. In this post hoc analysis of pooled data from four RCTs, we compared the efficacy of tiotropium/olodaterol versus tiotropium as maintenance therapy in patients with COPD who were not receiving maintenance treatment with long-acting muscarinic antagonists (LAMAs), long-acting β2-agonists (LABAs) or inhaled corticosteroids (ICS) ("maintenance naïve") at study entry. METHODS TONADO® 1/2 (52 weeks) and OTEMTO® 1/2 (12 weeks) were phase III RCTs in patients with COPD. TONADO 1/2 and OTEMTO 1/2 enrolled patients with post-bronchodilator forced expiratory volume in 1 s (FEV1) < 80% predicted (lower limit FEV1 ≥ 30% in OTEMTO 1/2 only). We examined the effect of tiotropium/olodaterol 5/5 µg versus tiotropium 5 µg on trough FEV1 response, St. George's Respiratory Questionnaire (SGRQ) total score and Transition Dyspnoea Index (TDI) focal score at 12 weeks in four pooled studies. RESULTS The pooled analysis included 1078 maintenance-naïve patients. There were significant improvements with tiotropium/olodaterol versus tiotropium in trough FEV1 [0.056 L; 95% confidence interval (CI) 0.033, 0.079; P < 0.0001], SGRQ score (- 1.780; 95% CI - 3.126 to - 0.434; P = 0.0096) and TDI score (0.409; 95% CI 0.077, 0.741; P = 0.0158) at week 12. For patients receiving tiotropium/olodaterol, the odds of achieving a minimal clinically important difference from baseline in any of the analysed outcomes (FEV1 ≥ 0.1 L, SGRQ ≥ 4.0 points or TDI ≥ 1.0 point) were higher versus tiotropium. CONCLUSIONS In patients who were maintenance naïve at baseline, treatment initiation with tiotropium/olodaterol resulted in greater improvements in lung function, health status and dyspnoea severity compared with tiotropium alone, without compromising patient safety. These results support the use of dual bronchodilation with tiotropium/olodaterol as first-line maintenance treatment in patients with COPD. TRIAL REGISTRATION ClinicalTrials.gov: TONADO® 1 and 2 (NCT01431274 and NCT01431287, registered 8 September 2011) and OTEMTO® 1 and 2 (NCT01964352 and NCT02006732, registered 14 October 2013).
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Affiliation(s)
- Roland Buhl
- Pulmonary Department, Johannes Gutenberg Universitat Mainz, Mainz, Germany.
| | - Alberto de la Hoz
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Wenqiong Xue
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
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Wang Z, Tadayasu Y, Hu N, Shu S, Hu C, Luo Z. Pharmacokinetics and safety of tiotropium+olodaterol 5 μg/5 μg fixed-dose combination in Chinese patients with COPD. Pulm Pharmacol Ther 2020; 63:101944. [PMID: 32916296 DOI: 10.1016/j.pupt.2020.101944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/21/2020] [Accepted: 08/29/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality worldwide and in China. For patients with more severe symptoms, initial treatment with long acting β2-agonists and long-acting muscarinic antagonists combination therapy is recommended. Tiotropium + olodaterol fixed-dose combination (Tio + Olo FDC) is an aqueous solution of tiotropium bromide and olodaterol delivered by the RESPIMAT® Soft Mist™ inhaler for patients with moderate to very severe COPD. METHODS This single site, open-label, phase Ib clinical study assessed the pharmacokinetic (PK) and safety profiles of once-daily Tio + Olo FDC (5 μg/5 μg) after single dose and at steady state in Chinese patients with moderate to severe COPD over 3 weeks. The PK and safety profiles of Japanese and Caucasian populations from 2 independent COPD studies were provided for comparison. RESULTS A total of 12 Chinese patients received Tio + Olo FDC. After multiple inhaled administration of Tio + Olo FDC, tiotropium and olodaterol were rapidly absorbed and reached peak plasma concentration at about 5 and 25 min, respectively. The accumulation ratios after multiple administrations were 1.3 and 1.6 for tiotropium and olodaterol in Chinese patients. Tio + Olo FDC was well-tolerated; all AEs were mild. CONCLUSION Tio + Olo FDC (5 μg/5 μg) was rapidly absorbed and had a good safety profile in Chinese patients with COPD.
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Affiliation(s)
- Zhenlei Wang
- GCP Center/Institute of Drug Clinical Trials, West China Hospital, Sichuan University, People's Republic of China
| | | | - Na Hu
- Boehringer Ingelheim (China) Investment Corporation Limited, Shanghai, People's Republic of China
| | - Shiqing Shu
- GCP Center/Institute of Drug Clinical Trials, West China Hospital, Sichuan University, People's Republic of China
| | - Chao Hu
- GCP Center/Institute of Drug Clinical Trials, West China Hospital, Sichuan University, People's Republic of China
| | - Zhu Luo
- GCP Center/Institute of Drug Clinical Trials, West China Hospital, Sichuan University, People's Republic of China.
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Buhl R, Singh D, de la Hoz A, Xue W, Ferguson GT. Benefits of Tiotropium/Olodaterol Compared with Tiotropium in Patients with COPD Receiving only LAMA at Baseline: Pooled Analysis of the TONADO ® and OTEMTO ® Studies. Adv Ther 2020; 37:3485-3499. [PMID: 32462607 PMCID: PMC7370969 DOI: 10.1007/s12325-020-01373-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report recommends long-acting muscarinic antagonists (LAMA) or long-acting β2-agonists (LABA) as first-line treatment for chronic obstructive pulmonary disease (COPD), but many patients remain symptomatic on monotherapy and escalation to dual-bronchodilator therapy may be warranted. METHODS TONADO® 1&2 and OTEMTO® 1&2 assessed lung function and patient-reported outcomes in patients with moderate-to-severe (OTEMTO) or moderate-to-very-severe (TONADO) COPD. This pooled post hoc analysis included patients treated with LAMA monotherapy at baseline who were randomised to receive either 5 µg tiotropium (LAMA) or 5/5 µg tiotropium/olodaterol (LAMA/LABA). We assessed changes from baseline and responder rates for trough forced expiratory volume in 1 s (FEV1), St. George's Respiratory Questionnaire (SGRQ) and the Transition Dyspnoea Index (TDI). RESULTS Overall, 151 patients received tiotropium; 148 received tiotropium/olodaterol. Mean differences from baseline with tiotropium/olodaterol versus tiotropium were + 0.074 l (95% confidence interval [CI] 0.033, 0.115; P = 0.0004) for trough FEV1, - 2.675 (95% CI - 5.060, - 0.291; P = 0.0280) for SGRQ and 1.148 (95% CI 0.564, 1.732; P = 0.0001) for TDI. Patients were more likely to respond when treated with tiotropium/olodaterol versus tiotropium for trough FEV1 (odds ratio [OR] 3.14, 95% CI 1.94, 5.06; P < 0.0001), SGRQ (OR 1.49, 95% CI 0.93, 2.40; P = 0.0980) and TDI (OR 2.81, 95% CI 1.71, 4.60; P < 0.0001). Minimum clinically important difference from baseline in any of the analysed outcomes (FEV1 ≥ 0.1 l, SGRQ ≥ 4.0 points or TDI ≥ 1.0 point) was more likely in patients treated with tiotropium/olodaterol versus tiotropium (OR 2.43, 95% CI 1.32, 4.51; P = 0.0046). CONCLUSION In patients with COPD receiving only LAMA monotherapy, treatment escalation to tiotropium/olodaterol resulted in statistically significant and clinically relevant improvements in lung function, health status and breathlessness. These results support early therapy optimisation to dual bronchodilation with tiotropium/olodaterol in patients receiving tiotropium alone. TRIAL REGISTRATION TONADO® 1 was registered in the US National Library of Medicine on 9 September 2011 (Clinicaltrials.gov: NCT01431274). TONADO® 2 was registered in the US National Library of Medicine on 9 September 2011 (Clinicaltrials.gov: NCT01431287). OTEMTO® 1 was registered in the US National Library of Medicine on 17 October 2013 (Clinicaltrials.gov: NCT01964352). OTEMTO® 2 was registered in the US National Library of Medicine on 10 December 2013 (Clinicaltrials.gov: NCT02006732).
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Affiliation(s)
- Roland Buhl
- Pulmonary Department, Johannes Gutenberg University Hospital, Mainz, Germany.
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Alberto de la Hoz
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Wenqiong Xue
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
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Kang K, Kim HH, Choi Y. Tiotropium is Predicted to be a Promising Drug for COVID-19 Through Transcriptome-Based Comprehensive Molecular Pathway Analysis. Viruses 2020; 12:E776. [PMID: 32698440 PMCID: PMC7412475 DOI: 10.3390/v12070776] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects almost everyone in the world in many ways. We previously predicted antivirals (atazanavir, remdesivir and lopinavir/ritonavir) and non-antiviral drugs (tiotropium and rapamycin) that may inhibit the replication complex of SARS-CoV-2 using our molecular transformer-drug target interaction (MT-DTI) deep-learning-based drug-target affinity prediction model. In this study, we dissected molecular pathways upregulated in SARS-CoV-2-infected normal human bronchial epithelial (NHBE) cells by analyzing an RNA-seq data set with various bioinformatics approaches, such as gene ontology, protein-protein interaction-based network and gene set enrichment analyses. The results indicated that the SARS-CoV-2 infection strongly activates TNF and NFκB-signaling pathways through significant upregulation of the TNF, IL1B, IL6, IL8, NFKB1, NFKB2 and RELB genes. In addition to these pathways, lung fibrosis, keratinization/cornification, rheumatoid arthritis, and negative regulation of interferon-gamma production pathways were also significantly upregulated. We observed that these pathologic features of SARS-CoV-2 are similar to those observed in patients with chronic obstructive pulmonary disease (COPD). Intriguingly, tiotropium, as predicted by MT-DTI, is currently used as a therapeutic intervention in COPD patients. Treatment with tiotropium has been shown to improve pulmonary function by alleviating airway inflammation. Accordingly, a literature search summarized that tiotropium reduced expressions of IL1B, IL6, IL8, RELA, NFKB1 and TNF in vitro or in vivo, and many of them have been known to be deregulated in COPD patients. These results suggest that COVID-19 is similar to an acute mode of COPD caused by the SARS-CoV-2 infection, and therefore tiotropium may be effective for COVID-19 patients.
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Affiliation(s)
- Keunsoo Kang
- Department of Microbiology, College of Science & Technology, Dankook University, Cheonan 31116, Korea;
| | - Hoo Hyun Kim
- Department of Microbiology, College of Science & Technology, Dankook University, Cheonan 31116, Korea;
| | - Yoonjung Choi
- Deargen Inc., Daejeon, Yuseong-gu, Munji-dong 103-6, Korea
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Kalemci S, Sarihan A, Kargı AB, Şimşek A, Zeybek A. Re: Yildiz BP, Bayraktaroglu M, Gunen H. Bronchodilator efficacy of tiotropium/formoterol (18/12 μg once daily via a Discair inhaler), tiotropium alone (18 μg by Handihaler) or combined with formoterol (12 μg twice daily by Aerolizer) in adults with moderate-to-severe stable COPD. Curr Med Res Opin. 2019;35(12):2187-2196. Curr Med Res Opin 2020; 36:1059. [PMID: 32270717 DOI: 10.1080/03007995.2020.1754184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Aydin Sarihan
- Manisa Sehir Hastanesi, Manisa City Hospital, Manisa, Turkey
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Yildiz BP, Bayraktaroglu M, Gunen H. Reply: Re: Yildiz BP, Bayraktaroglu M, Gunen H. Bronchodilator efficacy of tiotropium/formoterol (18/12 μg once daily via a discair inhaler), tiotropium alone (18 μg by handihaler) or combined with formoterol (12 μg twice daily by aerolizer) in adults with moderate-to-severe stable COPD. Curr Med Res Opin. 2019;35(12):2187-2196. Curr Med Res Opin 2020; 36:1061-1062. [PMID: 32270722 DOI: 10.1080/03007995.2020.1754187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Birsen Pinar Yildiz
- Department of Pulmonary Medicine, University of Health Sciences, Yedikule Research and Training Centre for Chest Diseases and Thoracic Surgery Istanbul, Turkey
| | - Mesut Bayraktaroglu
- Department of Pulmonary Medicine, University of Health Sciences, Yedikule Research and Training Centre for Chest Diseases and Thoracic Surgery Istanbul, Turkey
| | - Hakan Gunen
- Sureyyapasa Training and Research Centre for Chest Diseases and Thoracic Surgery, Istanbul, Turkey
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Doherty DE, Bleecker ER, Moroni-Zentgraf P, Zaremba-Pechmann L, Kerstjens HAM. Tiotropium Respimat Efficacy and Safety in Asthma: Relationship to Age. J Allergy Clin Immunol Pract 2020; 8:2653-2660.e4. [PMID: 32320797 DOI: 10.1016/j.jaip.2020.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Data are limited on the differential response to long-acting bronchodilators in older versus younger adults with asthma. OBJECTIVE To determine whether the response to tiotropium Respimat differed in older versus younger patients with asthma. METHODS Post hoc analyses of 4 randomized, double-blind, placebo-controlled studies in adults with asthma were carried out. Two studies compared tiotropium Respimat 5 μg once daily with placebo, both added to high-dose inhaled corticosteroid (ICS) plus long-acting β2-agonist (ie, severe asthma). The other 2 evaluated tiotropium Respimat 2.5 or 5 μg once daily, salmeterol 50 μg twice daily, or placebo, all added to medium-dose ICS (moderate asthma). Data were analyzed in 2 pools: (1) severe and (2) moderate asthma. Efficacy end points: trough and peak FEV1; trough forced vital capacity; Asthma Control Questionnaire total score and responder percentage, all at week 24. One set of analyses was performed with age as a continuous covariate; the second was conducted in categories less than 40, 40 to 60, and more than 60 years, with treatment-by-age subgroup interaction P values obtained. Safety was analyzed in age categories. RESULTS Across the age categories, treatment-by-age subgroup interaction P values for trough FEV1 were .13 and .77 for patients with severe and moderate asthma, respectively, not indicating significant impact of age on overall treatment effect, with this observation replicated in the 2 continuum analyses. The other end points (including safety) were also not impacted by age. CONCLUSIONS Once-daily tiotropium Respimat add-on to ICS or ICS/long-acting β2-agonist therapy was effective and well tolerated in patients with asthma independent of age.
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Affiliation(s)
| | | | | | | | - Huib A M Kerstjens
- University of Groningen, University Medical Center Groningen, and Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
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He J, Lin JT. A comparison of tiotropium/olodaterol vs tiotropium alone in terms of treatment effect for chronic obstructive pulmonary disease: A meta-analysis. Medicine (Baltimore) 2020; 99:e19789. [PMID: 32311990 PMCID: PMC7440302 DOI: 10.1097/md.0000000000019789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Combinations of long-acting bronchodilators with different mechanisms of action are recommended to improve prognosis and reduce risk of adverse events of chronic obstructive pulmonary disease (COPD). It is unclear whether the new combination therapy with long-acting muscarinic antagonist (LAMA) tiotropium (TIO) and long acting beta-agonists (LABA) olodaterol (OLO) was superior to tiotropium alone. METHODS We measured the efficacy of the TIO/OLO combination vsTIO alone for COPD patients based on electronic databases up to February 2019. After rigorous quality review, data was extracted from eligible trials. All the main outcomes were pooled analysis using RevMan software. RESULTS A total of 6 randomized controlled trials (RCTs) were identified. The pooled results of our meta-analysis demonstrated that FEV1 [MD = 0.03, 95% CI (-0.01,0.07), P = .18], FVC [MD = -0.03, 95%CI (-0.06,0.00), P = .09] and FEV1%pred [MD = 0.35, 95%CI (-0.30, 0.99), P = .29] all showed no significant difference between the 2 groups. The overall incidence of adverse effects (AEs) [OR = 1.01,95%CI (0.93,1.09), P = .87] and serious AEs [OR = 1.04,95% CI (0.82, 1.32), P = .72] in the combination group was similar to that of the TIO alone group, without statistical significance. CONCLUSION These studies reported that the TIO/OLO combination did not show superior effects than tiotropium alone for COPD. Additionally, both therapies were well tolerated.
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Abstract
Exacerbations of persistent or intermittent asthma should be anticipated by physicians and health-care professionals. Patients who are likely to experience an exacerbation often have a history of an exacerbation in the previous year, and the absolute eosinophil count in peripheral blood is ≥ 400/μL. Similarly, expectorated or induced sputum eosinophilia of ≥2% is associated with exacerbations. These phenotypic findings have led to effective biologic therapies, which target eosinophils or immunoglobulin E or the T-helper type 2 phenotype, especially in children, adolescents, and adults with frequent exacerbations. In children, a reduced forced expiratory volume in the first second of expiration (FEV1) to forced vital capacity ratio can be associated with future exacerbations, although the FEV1 may be in the normal range, even with children who have persistent severe asthma. Asthma control questionnaires did not differentiate between children with or children without a future exacerbation. Alternatively, in adults, the lower baseline FEV1 (2.3 L [74% predicted] versus 2.5 L [78% predicted]) identified patients more likely to have a future exacerbation compared with patients who were not having an exacerbation. After correcting for FEV1, the asthma control questionnaire data were associated with exacerbations. In adolescents (ages ≥ 12 years) and adults with persistent mild asthma, most (73%) did not have sputum eosinophilia, and some of these patients responded well to the anticholinergic, tiotropium, which would argue differently from administration of an inhaled corticosteroid as first-line controller therapy. In a three-track study of patients with persistent mild asthma, as-needed budesonide-formoterol and scheduled budesonide were associated with approximately one-half of the annual exacerbation rate of as-needed albuterol. In patients with persistent moderate-to-severe asthma, tiotropium added to controller therapy caused an increase in FEV1 without improving the asthma control questionnaire findings. There were two studies that explored whether either quadrupling or quintupling the inhaled corticosteroid at the first sign of loss of control of asthma would provide meaningful reductions of severe exacerbations of asthma, but the findings did not support this strategy. Both biologic therapies and environmental control (dust mite impermeable encasings) have resulted in reductions of exacerbations in patients with persistent moderate and severe asthma.
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Caillaud D, Costes F, Chalmet P, Payen F. Allergic Bronchopulmonary Candidiasis Mimicking COPD. Am J Med 2019; 132:e797-e798. [PMID: 31226246 DOI: 10.1016/j.amjmed.2019.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Denis Caillaud
- Pulmonary Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France; Centre Hospitalier Universitaire Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
| | - Frederic Costes
- Centre Hospitalier Universitaire Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Sports Medicine and Functional Explorations Unit, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Chalmet
- Pulmonary Department, Centre Hospitalier Montluçon, Montluçon, France
| | - Florent Payen
- Pulmonary Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France; Centre Hospitalier Universitaire Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
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Meng JF, Li H, Luo MJ, Li HB. Efficacy of tiotropium in treating patients with moderate-to-severe asthma: A meta-analysis and systematic review based on 14 randomized controlled trials. Medicine (Baltimore) 2019; 98:e16637. [PMID: 31415357 PMCID: PMC6831397 DOI: 10.1097/md.0000000000016637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/03/2019] [Accepted: 07/05/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The goal of the current meta-analysis and systematic review was to explore the efficacy of tiotropium in treating patients with moderate-to-severe asthma on the basis of qualified randomized controlled trials (RCTs). METHODS The following online electronic databases, such as Cochrane, PubMed, and Embase database were screened to identify qualified studies updated to January 2019 through the use of index words. Several literatures that were relevant to the present analysis were also included. To further analyze the main outcomes, we utilized the odds rations (OR), and mean difference (MD) along with its 95% confidence interval (95% CI). RESULTS A total of 14 RCTs with 4998 patients in the tiotropium group and 5074 patients in the control group were included in the present study. On the basis of the pooled results, tiotropium was significantly associated with improved morning PEF (SMD: 3.29, 95%CI: 2.03-4.55), evening PEF (SMD: 3.36, 95%CI: 2.24-4.48), peak FEV (SMD: 2.67, 95%CI: 1.47-3.88), and trough FEV (SMD: 1.90, 95%CI: 0.87-2.92) vs the control group. Nevertheless, no significant difference was observed in peak FVC (SMD: 0.77, 95%CI: -0.21-1.76), trough FVC (SMD: 0.67, 95%CI: -0.18-1.53), AE (RR: 0.98, 95%CI: 0.94-1.02) and serious AE (RR: 1.08, 95%CI: 0.77-1.52) between the 2 groups. CONCLUSIONS In this review, we summarized the significant effect of tiotropium for the treatment of moderate-to-severe asthma, mainly in increasing morning PEF, evening PEF, peak FEV and trough FEV based on high-quality RCTs. Nevertheless, no significant difference in peak FVC, trough FVC, AE and serious AE was found between the 2 groups. A close comparison of the 2 groups revealed that more high-quality larger-sample RCTs are needed to gather more strong evidence on the therapeutic efficacy and safety of tiotropium for clinical practice.
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Abstract
Tiotropium/olodaterol (Stiolto® Respimat®; Spiolto® Respimat®) is an inhaled fixed-dose combination of the long-acting muscarinic antagonist tiotropium bromide (hereafter referred to as tiotropium) and the long-acting β2-adrenergic agonist olodaterol. It is available in several countries, including the USA, Japan, China and those of the EU, where it is indicated for the long-term maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). The efficacy of tiotropium/olodaterol 5/5 μg/day in patients with COPD was evaluated in phase III or IV trials of 6-52 weeks' duration. Tiotropium/olodaterol improved lung function to a greater extent than each of its individual components or placebo in 12- and 52-week trials. In 6-week trials, tiotropium/olodaterol provided greater lung function benefits over 24 h than the individual components, placebo or twice-daily fluticasone propionate/salmeterol. Tiotropium/olodaterol also demonstrated beneficial effects on health-related quality of life (HR-QoL), dyspnoea, inspiratory capacity, exercise endurance and the need for rescue medication. In an 8-week open-label trial, umeclidinium/vilanterol was superior to tiotropium/olodaterol for the primary endpoint of trough forced expiratory volume in 1 s. The tolerability profile of tiotropium/olodaterol was generally similar to that of the individual components. In conclusion, tiotropium/olodaterol provides a useful option for the maintenance treatment of COPD, with the convenience of once-daily administration via a single inhaler.
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Affiliation(s)
- Hannah A Blair
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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30
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Lazarus SC, Krishnan JA, King TS, Lang JE, Blake KV, Covar R, Lugogo N, Wenzel S, Chinchilli VM, Mauger DT, Dyer AM, Boushey HA, Fahy JV, Woodruff PG, Bacharier LB, Cabana MD, Cardet JC, Castro M, Chmiel J, Denlinger L, DiMango E, Fitzpatrick AM, Gentile D, Hastie A, Holguin F, Israel E, Jackson D, Kraft M, LaForce C, Lemanske RF, Martinez FD, Moore W, Morgan WJ, Moy JN, Myers R, Peters SP, Phipatanakul W, Pongracic JA, Que L, Ross K, Smith L, Szefler SJ, Wechsler ME, Sorkness CA. Mometasone or Tiotropium in Mild Asthma with a Low Sputum Eosinophil Level. N Engl J Med 2019; 380:2009-2019. [PMID: 31112384 PMCID: PMC6711475 DOI: 10.1056/nejmoa1814917] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In many patients with mild, persistent asthma, the percentage of eosinophils in sputum is less than 2% (low eosinophil level). The appropriate treatment for these patients is unknown. METHODS In this 42-week, double-blind, crossover trial, we assigned 295 patients who were at least 12 years of age and who had mild, persistent asthma to receive mometasone (an inhaled glucocorticoid), tiotropium (a long-acting muscarinic antagonist), or placebo. The patients were categorized according to the sputum eosinophil level (<2% or ≥2%). The primary outcome was the response to mometasone as compared with placebo and to tiotropium as compared with placebo among patients with a low sputum eosinophil level who had a prespecified differential response to one of the trial agents. The response was determined according to a hierarchical composite outcome that incorporated treatment failure, asthma control days, and the forced expiratory volume in 1 second; a two-sided P value of less than 0.025 denoted statistical significance. A secondary outcome was a comparison of results in patients with a high sputum eosinophil level and those with a low level. RESULTS A total of 73% of the patients had a low eosinophil level; of these patients, 59% had a differential response to a trial agent. However, there was no significant difference in the response to mometasone or tiotropium, as compared with placebo. Among the patients with a low eosinophil level who had a differential treatment response, 57% (95% confidence interval [CI], 48 to 66) had a better response to mometasone, and 43% (95% CI, 34 to 52) had a better response to placebo (P = 0.14). In contrast 60% (95% CI, 51 to 68) had a better response to tiotropium, whereas 40% (95% CI, 32 to 49) had a better response to placebo (P = 0.029). Among patients with a high eosinophil level, the response to mometasone was significantly better than the response to placebo (74% vs. 26%) but the response to tiotropium was not (57% vs. 43%). CONCLUSIONS The majority of patients with mild, persistent asthma had a low sputum eosinophil level and had no significant difference in their response to either mometasone or tiotropium as compared with placebo. These data provide equipoise for a clinically directive trial to compare an inhaled glucocorticoid with other treatments in patients with a low eosinophil level. (Funded by the National Heart, Lung, and Blood Institute; SIENA ClinicalTrials.gov number, NCT02066298.).
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Affiliation(s)
- Stephen C Lazarus
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Jerry A Krishnan
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Tonya S King
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Jason E Lang
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Kathryn V Blake
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Ronina Covar
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Njira Lugogo
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Sally Wenzel
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Vernon M Chinchilli
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - David T Mauger
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Anne-Marie Dyer
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Homer A Boushey
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - John V Fahy
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Prescott G Woodruff
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Leonard B Bacharier
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Michael D Cabana
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Juan C Cardet
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Mario Castro
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - James Chmiel
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Loren Denlinger
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Emily DiMango
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Anne M Fitzpatrick
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Deborah Gentile
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Annette Hastie
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Fernando Holguin
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Elliot Israel
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Daniel Jackson
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Monica Kraft
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Craig LaForce
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Robert F Lemanske
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Fernando D Martinez
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Wendy Moore
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Wayne J Morgan
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - James N Moy
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Ross Myers
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Stephen P Peters
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Wanda Phipatanakul
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Jacqueline A Pongracic
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Loretta Que
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Kristie Ross
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Lewis Smith
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Stanley J Szefler
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Michael E Wechsler
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
| | - Christine A Sorkness
- From the Division of Pulmonary and Critical Care Medicine and the Cardiovascular Research Institute (S.C.L., H.A.B., J.V.F., P.G.W.) and the Department of Pediatrics, Epidemiology, and Biostatistics (M.D.C.), University of California, San Francisco, San Francisco; the University of Illinois at Chicago (J.A.K.), the Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert Lurie Children's Hospital of Chicago (J.A.P.), and Northwestern University, Feinberg School of Medicine (L.S.) - all in Chicago; the Department of Public Health Sciences, Penn State University, Hershey (T.S.K., V.M.C., D.T.M., A.-M.D.), and the University of Pittsburgh Asthma Institute (S.W., F.H.) and Allegheny General Hospital (D.G.), Pittsburgh - all in Pennsylvania; Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L., K.V.B.), and Nemours Children's Health System, Jacksonville (J.E.L., K.V.B.) - both in Florida; the Department of Pediatrics and Medicine, National Jewish Health, Denver (R.C., S.J.S., M.E.W.), and Children's Hospital Colorado, Aurora (R.C., S.J.S., M.E.W.) - both in Colorado; Duke Allergy, Asthma, and Airway Center, Duke University School of Medicine, Durham (N.L., M.K., L.Q.), Wake Forest University School of Medicine, Winston-Salem (A.H., W.M., S.P.P.), and North Carolina Clinical Research, Raleigh (C.L.) - all in North Carolina; the Departments of Pediatrics and Medicine, Washington University in St. Louis School of Medicine, St. Louis (L.B.B., M.C.); Brigham and Women's Hospital and Harvard Medical School (J.C.C., E.I.) and Boston Children's Hospital (W.P.) - all in Boston; Rainbow Babies and Children's Hospital, Cleveland (J.C., R.M., K.R.); the University of Wisconsin, Madison (L.D., D.J., R.F.L., C.A.S.); Columbia University, New York (E.D.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); and the Arizona Respiratory Center, University of Arizona, Tucson (F.D.M., W.J.M.)
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Abstract
Maintenance bronchodilator therapy with long-acting β-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) is the cornerstone treatment for patients with stable chronic obstructive pulmonary disease (COPD). Fixed-dose combinations (FDCs) of LABA/LAMA are recommended for the majority of symptomatic COPD patients by global guidelines; regional guidelines such as the Japanese and Korean guidelines also provide similar recommendations for the use of LABA/LAMA FDCs. This review comprehensively describes the latest clinical evidence from key studies on the efficacy and safety of four approved LABA/LAMA fixed-dose combinations: indacaterol/glycopyrronium, vilanterol/umeclidinium, formoterol/aclidinium, and olodaterol/tiotropium. Additionally, in this review we describe the rationale behind the use of LABA/LAMA FDC therapy, key findings from the preclinical and clinical trial evaluation of respective LABA and LAMA monocomponents, and the efficacy and safety of LABA/LAMA FDCs. Special emphasis is placed on the clinical evidence for the monocomponents and LABA/LAMA FDCs from the Asian population. This detailed overview of the efficacy and safety of LABA/LAMA FDCs in global and Asian COPD patients is envisaged to provide a better understanding of the benefits of these therapies and to inform healthcare providers and patients on their appropriate use.Funding: Novartis Pharma K.K.
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Affiliation(s)
- Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | | | - Rahul Lad
- Novartis Healthcare Pvt. Ltd., Hyderabad, India
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Hoogendoorn M, Corro Ramos I, Baldwin M, Luciani L, Fabron C, Detournay B, Rutten-van Mölken MPMH. Long-term cost-effectiveness of the fixed-dose combination of tiotropium plus olodaterol based on the DYNAGITO trial results. Int J Chron Obstruct Pulmon Dis 2019; 14:447-456. [PMID: 30863045 PMCID: PMC6388779 DOI: 10.2147/copd.s191031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Combinations of long-acting bronchodilators are recommended to reduce the rate of COPD exacerbations. Evidence from the DYNAGITO trial showed that the fixed-dose combination of tiotropium + olodaterol reduced the annual rate of total exacerbations (P<0.05) compared with tiotropium monotherapy. This study aimed to estimate the cost-effectiveness of the fixed-dose combination of tiotropium + olodaterol vs tiotropium monotherapy in COPD patients in the French setting. PATIENTS AND METHODS A recently developed COPD patient-level simulation model was used to simulate the lifetime effects and costs for 15,000 patients receiving either tiotropium + olodaterol or tiotropium monotherapy by applying the reduction in annual exacerbation rate as observed in the DYNAGITO trial. The model was adapted to the French setting by including French unit costs for treatment medication, COPD maintenance treatment, COPD exacerbations (moderate or severe), and pneumonia. The main outcomes were the annual (severe) exacerbation rate, the number of quality-adjusted life-years (QALYs), and total lifetime costs. RESULTS The number of QALYs for treatment with tiotropium + olodaterol was 0.042 higher compared with tiotropium monotherapy. Using a societal perspective, tiotropium + olodaterol resulted in a cost increase of +€123 and an incremental cost-effectiveness ratio (ICER) of €2,900 per QALY compared with tiotropium monotherapy. From a French National Sickness Fund perspective, total lifetime costs were reduced by €272 with tiotropium + olodaterol, resulting in tiotropium + olodaterol being the dominant treatment option, that is, more effects with less costs. Sensitivity analyses showed that reducing the cost of exacerbations by 34% increased the ICER to €15,400, which could still be considered cost-effective in the French setting. CONCLUSION Treatment with tiotropium + olodaterol resulted in a gain in QALYs and savings in costs compared with tiotropium monotherapy using a National Sickness Fund perspective in France. From the societal perspective, tiotropium + olodaterol was found to be cost-effective with a low cost per QALY.
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Affiliation(s)
- Martine Hoogendoorn
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, the Netherlands,
| | - Isaac Corro Ramos
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, the Netherlands,
| | | | | | | | | | - Maureen P M H Rutten-van Mölken
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, the Netherlands,
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands
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Xiong XF, Fan LL, Wu HX, Zhu M, Cheng DY. Effects of Tiotropium Combined with Theophylline on Stable COPD Patients of Group B, D and its Impact on Small Airway Function: A Randomized Controlled Trial. Adv Ther 2018; 35:2201-2213. [PMID: 30415298 PMCID: PMC6267715 DOI: 10.1007/s12325-018-0831-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Tiotropium bromide has been widely used in clinical practice, while theophylline is another treatment option for chronic obstructive pulmonary disease (COPD). However, only a few relevant studies have investigated the long-term outcomes and efficacy of both in patients with COPD. We evaluated the effects of tiotropium and low-dose theophylline on stable COPD patients of groups B and D. METHODS Eligible participants (n = 170) were randomized and received either tiotropium 18 µg once daily with theophylline 100 mg twice daily (Group I) or tiotropium 18 µg once daily (Group II) for 6 months. COPD assessment test (CAT), modified Medical Research Council (mMRC) dyspnea scores and pulmonary function tests were measured before randomization and during the treatment. RESULTS After 6 months of treatment, the CAT scores in both groups decreased significantly (11.41 ± 3.56 and 11.08 ± 3.05, p < 0.0001). The changes of CAT (p = 0.028) and mMRC scores (p = 0.049) between the two groups differed after 1 month of treatment. In Group I, forced expiratory flow after 25% of the FVC% predicted (MEF25% pred) was significantly improved after 3 months (4.84 ± 8.73%, p < 0.0001) and 6 months (6.21 ± 8.65%, p < 0.0001). There was a significant difference in small airway function tests (MEF50% pred, MEF25% pred, and MMEF% pred) between the two groups after 6 month of treatment (p = 0.003, p < 0.0001, and p = 0.021, respectively). CONCLUSIONS Tiotropium combined with low-dose theophylline significantly improved the symptoms and general health of patients with stable COPD of groups B and D after 6 months of follow-up. Additionally, this therapy also improved the indicators of small airway function. TRIAL REGISTRATION Chinese Clinical Trial Registry (Registry ID: ChiCTR1800019027).
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Affiliation(s)
- Xiao-Feng Xiong
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Li-Li Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hong-Xia Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Min Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - De-Yun Cheng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Hamelmann E. Managing Severe Asthma: A Role for the Long-Acting Muscarinic Antagonist Tiotropium. Biomed Res Int 2018; 2018:7473690. [PMID: 30474042 PMCID: PMC6220412 DOI: 10.1155/2018/7473690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/30/2018] [Accepted: 10/01/2018] [Indexed: 11/17/2022]
Abstract
Severe asthma is associated with substantial morbidity and mortality. Therapies must be maximized to gain control of a patient's severe asthma; however, avoiding overtreatment is also important. The mainstays of asthma maintenance treatment are inhaled corticosteroids (ICS) and long-acting β 2-agonsits (LABAs), with the option of supplementary add-on treatments. New add-on treatments for severe asthma have emerged over the past two decades, including personalized biological therapies that are guided by a patient's asthma phenotype. In addition, the long-acting muscarinic antagonist tiotropium has been recommended as an add-on treatment for severe asthma. Phase III clinical trials have shown tiotropium in combination with ICS/LABA to be efficacious in patients with severe asthma. Further analyses of clinical trial data have indicated that there is no benefit in stratifying patients by phenotype to predict tiotropium efficacy. Furthermore, health economic studies suggest tiotropium to be a cost-effective treatment in patients with severe asthma. This review will present the evidence surrounding the role of tiotropium in severe asthma and will discuss the use of tiotropium add-on therapy before personalized medicine strategies in the stepwise process of gaining asthma control.
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Affiliation(s)
- Eckard Hamelmann
- Children's Center Bethel, Ev. Klinikum Bielefeld gGmbH, Grenzweg 10, 33617 Bielefeld, Germany
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Hashimoto S, Casale TB, Engel M, Moroni-Zentgraf P, Bour LJ, Kerstjens HAM. Efficacy of tiotropium in adults with moderate asthma, by leukotriene receptor antagonist use at baseline. Allergol Int 2018; 67:411-413. [PMID: 29398589 DOI: 10.1016/j.alit.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/15/2017] [Accepted: 11/17/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Shu Hashimoto
- Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Thomas B Casale
- Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Michael Engel
- TA Respiratory Diseases, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Petra Moroni-Zentgraf
- TA Respiratory Diseases, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Louis J Bour
- Biostatistics, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Huib A M Kerstjens
- University of Groningen, Department of Pulmonary Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Bell CF, Coutinho AD, Farrelly E, Lokhandwala T, Landsman-Blumberg P. Clinical and economic outcomes associated with the use of fluticasone propionate 250 mcg and salmeterol 50 mcg combination versus tiotropium bromide 18 mcg as initial maintenance treatment for chronic obstructive pulmonary disease in managed care. J Med Econ 2018; 21:629-638. [PMID: 29577787 DOI: 10.1080/13696998.2018.1457532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIMS To examine the clinical and economic outcomes associated with the use of long-acting bronchodilators for initial maintenance treatment of chronic obstructive pulmonary disease (COPD) by analyzing health insurance claims data in the US. METHODS A retrospective, observational, matched cohort study used health insurance claims data (January 2008 to June 2013) to assess COPD-related outcomes for subjects aged ≥40 years. Subjects were assigned to a study cohort according to the first observed prescription fill for a long-acting bronchodilator (fluticasone propionate 250 mcg/salmeterol 50 mcg [FSC] or tiotropium bromide 18 mcg [TIO]). The analysis period for each subject comprised a 1-year pre-index date and 1-year post-index date. Primary outcome measure was total COPD-related costs per-patient per-year (PPPY) during the follow-up period. Secondary outcome measures included COPD-related exacerbations and the components of COPD-related costs. RESULTS Overall, 24,040 subjects were identified; the analysis sample consisted of 19,090 subjects (9,545 per cohort) with no significant differences between cohorts. Mean COPD-related total costs PPPY were numerically lower among the FSC cohort; however, the difference was not statistically significant ($2,224 [±4,108] vs $2,352 [±3,721], p = .057). There was no difference between cohorts for COPD-related medical costs (p = .894). COPD-related pharmacy costs were significantly, yet modestly, lower in the FSC cohort compared with the TIO cohort ($1,160 [±1,106] vs 1,275 [±1,110], p < .001). There were no statistically significant differences in the rate or number of exacerbations between the matched cohorts. LIMITATIONS While propensity scoring achieved balance in baseline characteristics, some residual confounding unobserved in the database may be present. CONCLUSIONS Few clinical and economic differences between subjects initiating maintenance therapy with FSC or TIO were observed.
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Nagar S, Patel J, Stanford RH. Characteristics and health care resource use of subjects with COPD in the year before initiating LAMA monotherapy or LAMA+LABA combination therapy: A U.S. database study. Manag Care 2018; 27:40-47. [PMID: 29763411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To characterize subjects with chronic obstructive pulmonary disease (COPD) newly initiated on long-acting muscarinic antagonists (LAMA) or dual LAMA/long-acting β2-adrenergic agonist (LABA) therapy. DESIGN This pilot/preliminary analysis was a retrospective crosssectional study of subjects with COPD from the Optum Impact National Managed Care Benchmark Database. METHODOLOGY Subjects with at least one LAMA prescription in the index period (July 2008-June 2009) were included and stratified by treatment. Data were collected in the year before the index date and included comorbidities, medication use, COPD-related costs, health care resource use, and exacerbations. RESULTS Of 5,311 eligible subjects, 2,057 initiated LAMA therapy (LAMA cohort) and 191 initiated LAMA+LABA therapy (LAMA+LABA cohort). The Charlson comorbidity index was slightly lower in the LAMA+LABA cohort than the LAMA cohort (mean±SD: 0.63±1.13 vs. 0.66±1.28), but the number of prescriptions was higher (mean±SD: 42.9±23.2 vs. 30.5±27.2). The LAMA+LABA cohort had higher short-acting inhaled β2 agonist (56.0% vs. 35.7%), oral corticosteroid (37.7% vs. 32.6%), and home oxygen therapy use (14.1% vs. 3.2%) than the LAMA cohort. Total medical costs were greater in the LAMA+LABA cohort than the LAMA cohort (mean±SD: $3,320.40±4085.9 vs. $1,226.20±3602.9), although emergency department ($11.00±66.8 vs. $30.70±259.2) and outpatient visit ($39.60±163.1 vs. $41.70±424.3) costs were lower. Resource use and exacerbation incidence were similar between cohorts. CONCLUSION In this first look, subjects with COPD initiating LAMA or LAMA+LABA therapy exhibited different clinical and resource use characteristics in the year before treatment. Subjects receiving LAMA+LABA were older, with higher COPD co-medication use, more prescriptions, and associated higher pharmacy costs compared with subjects initiating LAMA. These differences may reflect a higher severity of COPD in those starting LABA+LAMA treatment.
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Ielpo A, Crisafulli E. When Two Drugs Are Better than Three: Re-Modulating the Therapeutic Plan of a Chronic Obstructive Pulmonary Disease Patient. Respiration 2018; 95 Suppl 1:6-10. [PMID: 29705779 DOI: 10.1159/000487173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We present the case of a 77-year-old man diagnosed with chronic obstructive pulmonary disease (COPD) stage D with emphysema phenotype and treated with triple therapy (salmeterol, fluticasone propionate, and tiotropium) for 1 year without relevant improvements in exertional dyspnea and disease impact. After switching to combination therapy with a long-acting β2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) (indacaterol/glycopyrronium), we observed, in a 3-month period, a substantial reduction of the modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) scores. Moreover, the patient reported a reduction of dynamic hyperinflation and an improvement of ventilatory response to exercise.
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Ichinose M, Minakata Y, Motegi T, Ueki J, Gon Y, Seki T, Anzai T, Nakamura S, Hirata K. Efficacy of tiotropium/olodaterol on lung volume, exercise capacity, and physical activity. Int J Chron Obstruct Pulmon Dis 2018; 13:1407-1419. [PMID: 29750027 PMCID: PMC5936008 DOI: 10.2147/copd.s166023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose This study evaluated the efficacy of tiotropium/olodaterol vs tiotropium on lung function, exercise capacity, and physical activity in patients with COPD. Patients and methods A total of 184 patients aged ≥40 years with COPD (Global Initiative for Chronic Obstructive Lung Disease stage II-IV) received tiotropium/olodaterol for 6 weeks, then tiotropium for 6 weeks, or vice versa. The primary endpoint was inspiratory capacity (IC) at peak post-dose. Results Adjusted mean IC after 6-week treatment was 1.990 L with tiotropium/olodaterol vs 1.875 L with tiotropium (difference: 115 mL; 95% CI: 77, 153; p<0.0001). Forced expiratory volume in 1 s (difference: 105 mL; 95% CI: 88, 123), forced vital capacity (difference: 163 mL; 95% CI: 130, 197), and slow vital capacity (difference: 134 mL; 95% CI: 91, 176) improved with tiotropium/olodaterol (all p<0.0001). Adjusted mean 6-min walk distance was similar between treatments in the overall population but was significantly increased with tiotropium/olodaterol in the subgroup with Global Initiative for Chronic Obstructive Lung Disease stage III/IV at baseline (difference: 18.1 m; 95% CI: 2.3, 33.9; p=0.0254). In a post hoc analysis, tiotropium/olodaterol improved the values for ≥2.0 metabolic equivalents (difference: 5.0 min; 95% CI: 0.4, 9.7; p=0.0337). Conclusion Tiotropium/olodaterol significantly improved IC compared with tiotropium and potentially enhanced the exercise capacity in COPD patients. A slight improvement in physical activity of relatively more than moderate intensity was also seen with tiotropium/olodaterol.
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Affiliation(s)
- Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai
| | - Yoshiaki Minakata
- Department of Respiratory Medicine, National Hospital Organization Wakayama Hospital, Wakayama
| | - Takashi Motegi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo
| | - Jun Ueki
- Clinical Research Unit of Respiratory Pathophysiology, Juntendo University Graduate School of Health Care and Nursing, Chiba
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine
| | - Tetsuo Seki
- Medical Division, Nippon Boehringer Ingelheim Co., Ltd
| | - Tatsuhiko Anzai
- Clinical Information Division Data Science Center, Statistics Analysis Department 1, EPS Corporation, Tokyo
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Abstract
Asthma is one of the most common chronic diseases in children, with a high proportion of patients demonstrating poor control despite the availability of disease management guidelines. Global Initiative for Asthma guidelines include tiotropium as an add-on therapy option at Steps 4 and 5 in patients aged ≥ 12 years with a history of exacerbations, and tiotropium delivered via the Respimat® Soft Mist™ Inhaler has recently been approved for use as once-daily maintenance therapy for children with asthma over the age of 6 years in the USA. A large clinical trial program has been conducted in children, adolescents, and adults across the spectrum of asthma severity. Findings from these clinical studies and pooled analyses in children and adolescents with symptomatic moderate or severe asthma have demonstrated that tiotropium Respimat® as add-on to inhaled corticosteroids, with or without other maintenance therapies, is a well-tolerated and efficacious bronchodilator, showing improved lung function and trends towards improved asthma control, mirroring findings in adult studies. This review discusses the evidence to date for tiotropium Respimat® for the management of asthma in adolescents and children with symptomatic moderate and severe asthma, and considers the challenges of asthma management in these patients. Factors affecting this population group, such as poor adherence, underreporting of symptoms, and social and psychological issues, are highlighted, along with the need for active review and management of treatment to help achieve optimal control.
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Affiliation(s)
- Eckard Hamelmann
- Children's Center Bethel, Evangelisches Klinikum Bethel GmbH, Grenzweg 10, 33617, Bielefeld, Germany.
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA
- Breathing Institute, Children's Hospital Colorado, Aurora, USA
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Fukumitsu K, Kanemitsu Y, Asano T, Takeda N, Ichikawa H, Yap JMG, Fukuda S, Uemura T, Takakuwa O, Ohkubo H, Maeno K, Ito Y, Oguri T, Nakamura A, Takemura M, Niimi A. Tiotropium Attenuates Refractory Cough and Capsaicin Cough Reflex Sensitivity in Patients with Asthma. J Allergy Clin Immunol Pract 2018; 6:1613-1620.e2. [PMID: 29408386 DOI: 10.1016/j.jaip.2018.01.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/30/2017] [Accepted: 01/04/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Asthmatic cough is often refractory to standard treatments such as inhaled corticosteroids (ICS) and long-acting β2 agonists (LABA). Tiotropium may modulate cough reflex sensitivity of acute viral cough, but its efficacy in asthmatic cough remains unknown. OBJECTIVE To evaluate whether tiotropium improves cough and cough reflex sensitivity in patients with asthma refractory to ICS/LABA. METHODS Seventeen consecutive patients with asthma with chronic cough despite the use of ICS/LABA (13 women; 43.4 ± 19.0 years; average ICS dose, 651 ± 189 μg/d; fluticasone equivalent) were additionally treated with tiotropium (5 μg/d) for 4 to 8 weeks to examine its effects on pulmonary function and capsaicin cough reflex sensitivity (cough thresholds C2 and C5). Cough severity, cough-specific quality of life, and asthma control were also evaluated using cough visual analog scales (VASs), the Japanese version of Leicester Cough Questionnaire (J-LCQ), and Asthma Control Test (ACT), respectively. Patients with an improved cough VAS score of 15 mm or more were considered responders to tiotropium. RESULTS Tiotropium significantly improved cough VAS, J-LCQ, and ACT scores, but not FEV1. Changes in cough VAS score correlated with those in C2 (r = -0.58; P = .03), C5 (r = -0.58; P = .03), and ACT scores (r = -0.62; P = .02), but not in FEV1 in the overall patients. When analyses were confined to the 11 responders, tiotropium significantly improved capsaicin cough reflex sensitivity within the subgroup (C2: P = .01 and C5: P = .02) and versus the nonresponders (C2: P = .004 and C5: P = .02). CONCLUSION Tiotropium may alleviate asthmatic cough refractory to ICS/LABA by modulating cough reflex sensitivity but not through bronchodilation.
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Affiliation(s)
- Kensuke Fukumitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
| | - Takamitsu Asano
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Norihisa Takeda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Hiroya Ichikawa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Jennifer Maries Go Yap
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Satoshi Fukuda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Takehiro Uemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Osamu Takakuwa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Tetsuya Oguri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Atsushi Nakamura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Masaya Takemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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Meltzer EO, Berger WE. A review of the efficacy and safety of once-daily tiotropium Respimat 2.5 micrograms in adults and adolescents with asthma. Allergy Asthma Proc 2018; 39:14-26. [PMID: 29279056 DOI: 10.2500/aap.2018.39.4103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite current guidelines, many patients with asthma remain symptomatic, particularly those intolerant of, unresponsive to, or uncontrolled by long-acting beta 2-agonists (LABAs). Tiotropium bromide, delivered through the Respimat soft-mist inhaler in 2 puffs of 1.25 micrograms each, is approved for the long-term, maintenance treatment of asthma in patients aged ≥6 years. OBJECTIVE An overview of the use of once-daily tiotropium Respimat 2.5 micrograms in adults and adolescents with varying degrees of asthma severity. The role of the parasympathetic nervous system in the pathophysiology of asthma, the development of tiotropium for respiratory disease, and the value of the Respimat inhaler are also discussed. METHODS A literature search of all phase II and phase III trials of once-daily tiotropium Respimat 2.5 micrograms. RESULTS Once-daily tiotropium Respimat 2.5 micrograms was studied in five phase III studies: three studies in adults and two in adolescents aged 12-17 years. Tiotropium Respimat 2.5 micrograms demonstrated efficacy in adults and adolescents with mild, moderate, or severe asthma, showing significant improvements in lung function and asthma control in patients with uncontrolled asthma despite inhaled corticosteroids (ICS) or ICS plus LABA use. The adverse event profile of tiotropium was very acceptable, with safety similar to placebo. CONCLUSION Once-daily tiotropium Respimat 2.5 micrograms has positive attributes that include efficacy, a safety profile similar to placebo, once-daily dosing, administration by inhalation, and delivery in the easy-to-use and consistent-dosing Respimat device. However, more data are needed on the effects of tiotropium on clinical outcomes, patients' day-to-day lives, and real-world effectiveness.
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Abstract
BACKGROUND Cystic fibrosis is a life-limiting inherited condition which affects one in 2500 newborns in the UK and 70,000 children and adults worldwide. The condition is multifaceted and affects many systems in the body. The respiratory system is particularly affected due to a build up of thickened secretions and a predisposition to infection. Inhaled bronchodilators are prescribed for 80% of people with cystic fibrosis in order to widen the airways and alleviate symptoms. Both short- and long-acting inhaled bronchodilators are used to improve respiratory symptoms. Short-acting inhaled bronchodilators take effect in minutes and typically last for four to eight hours (muscarinic antagonists). Long-acting inhaled bronchodilators also take effect within minutes but typically last for around 12 hours and sometimes longer. This review is one of two which are replacing a previously published review of both long- and short-acting inhaled bronchodilators. OBJECTIVES This review aims to evaluate long-acting inhaled bronchodilators in children and adults with cystic fibrosis in terms of clinical outcomes and safety. If possible, we aimed to assess the optimal drug and dosage regimen. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.Date of last search: 10 October 2017.We also carried out a separate search of Embase and the reference lists of included trials. We searched clinical trials registries for any ongoing trials and made contact with pharmaceutical companies for any further trials.Date of Embase search: 11 October 2017. SELECTION CRITERIA Randomised or quasi-randomised parallel trials comparing long-acting inhaled bronchodilators (beta-2 agonists and muscarinic antagonists) with placebo, no treatment or a different long-acting inhaled bronchodilator in adults and children with cystic fibrosis. DATA COLLECTION AND ANALYSIS Both authors independently assessed trials for inclusion (based on title, abstract and full text). The authors independently assessed the included trials for quality and risk of bias and extracted data. Discrepancies were resolved by a third party. MAIN RESULTS The searches identified 195 unique references, of which 155 were excluded on title and abstract. We assessed the full texts of the remaining references, excluded 16 trials (28 references) and included four trials (12 references) in the review with 1082 participants.One trial (n = 16) measuring the effect of beta-2 agonists reported an improvement in forced expiratory volume at one second (FEV1) after treatment (at one month), but the trial was small with an unclear risk of bias so we judged the evidence to be very low quality. The trial did not report on participant-reported outcomes, quality of life or adverse events.Three trials (n = 1066) looked at the effects of the muscarinic antagonist tiotropium at doses of 2.5 µg and 5.0 µg in both the short term (up to 28 days) and the longer term (up to three months). Only one of the trials reported the change in FEV1 (L) after 28 days treatment and showed no significant difference between groups; with 2.5 µg tiotropium, mean difference (MD) -0.02 (95% confidence interval (CI) -0.13 to 0.09), or 5.0 µg tiotropium, MD 0.00 (95% CI -0.10 to 0.10) (moderate-quality evidence). All three trials of muscarinic antagonists provided data on adverse events which were found to differ little from placebo at doses of 2.5 µg, risk ratio (RR) 1.01 (95% CI 0.92 to 1.11) or 5.0 µg, RR 0.98 (95% CI 0.90 to 1.06). Very little participant-reported outcome data or quality of life data were available for analysis. Two of the trials were at low risk of bias overall whilst the remaining trial was at an unclear risk overall. AUTHORS' CONCLUSIONS Neither long-acting beta-2 agonists nor long-acting muscarinic antagonist bronchodilators demonstrate improvement in our primary outcome of FEV1. No difference was observed between intervention and placebo in terms of quality of life or adverse events. The quality of evidence for the use of beta-2 agonists was very low. The use of a long-acting inhaled bronchodilator may help to reduce the burden of treatment for people with cystic fibrosis as it is taken less often than a short-acting inhaled bronchodilator, but future trials would benefit from looking at the effects on our primary outcomes (spirometric changes from baseline, quality of life and adverse effects) in the longer term.
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Affiliation(s)
- Sherie Smith
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, The University of Nottingham, 1701 E Floor, East Block Queens Medical Centre, Nottingham, NG7 2UH, UK
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Feldman GJ, Sousa AR, Lipson DA, Tombs L, Barnes N, Riley JH, Patel S, Naya I, Compton C, Alcázar Navarrete B. Comparative Efficacy of Once-Daily Umeclidinium/Vilanterol and Tiotropium/Olodaterol Therapy in Symptomatic Chronic Obstructive Pulmonary Disease: A Randomized Study. Adv Ther 2017; 34:2518-2533. [PMID: 29094315 PMCID: PMC5702366 DOI: 10.1007/s12325-017-0626-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION We report the results of the first direct comparison of the once-daily fixed-dose long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) combinations umeclidinium/vilanterol (UMEC/VI) and tiotropium/olodaterol (TIO/OLO) in patients with COPD. METHODS This was a randomized, two-period crossover open-label study in symptomatic patients with COPD [age 40 years or older, postbronchodilator forced expiratory volume in 1 s (FEV1) of 70% or less and 50% or more of predicted normal values, and modified Medical Research Council Dyspnoea Scale score of 2 or greater] not receiving inhaled corticosteroid therapy. Patients were randomized to receive UMEC/VI (62.5/25 µg once daily) via a multidose dry powder inhaler (ELLIPTA) followed by TIO/OLO (5/5 µg once daily) via a soft mist inhaler (Respimat), each for 8 weeks with an interim 3-week washout or vice versa. The primary end point was the change from baseline in trough FEV1 at week 8 with a noninferiority margin of - 50 mL in the per-protocol (PP) population. The incidence of adverse events was also assessed. RESULTS In total, 236 patients (mean age 64.4 years, 60% male) were included in the intent-to-treat population and 227 were included in the PP population. UMEC/VI treatment was noninferior in the PP population and superior in the intent-to-treat population to TIO/OLO treatment with regard to trough FEV1 at week 8 [FEV1 change from baseline 180 mL vs 128 mL; difference 52 mL (95% confidence interval 28-77 mL); p < 0.001]. Patients receiving UMEC/VI had twofold increased odds of experiencing a clinically meaningful increase (100 mL or more) from baseline in trough FEV1 at week 8 compared with patients receiving TIO/OLO (odds ratio 2.05; 95% confidence interval 1.34-3.14). Adverse events occurred in 25% of patients in the UMEC/VI group and in 31% of patients in the TIO/OLO group. CONCLUSION In this first direct comparison of two once-daily fixed-dose LAMA/LABA combinations, superiority was observed for the primary end point of trough FEV1 at week 8 with UMEC/VI compared with TIO/OLO in patients with symptomatic COPD. Both treatments had similar safety profiles. These findings confirm the results of previous indirect LAMA/LABA comparisons, and show that an efficacy gradient exists within the LAMA/LABA class. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02799784. FUNDING GlaxoSmithKline.
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Affiliation(s)
| | - Ana R Sousa
- Respiratory Research and Development, GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex, UK
| | - David A Lipson
- Respiratory Research and Development, GlaxoSmithKline, King of Prussia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lee Tombs
- Precise Approach Ltd, Birmingham, West Midlands, UK
| | - Neil Barnes
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, Middlesex, UK
| | - John H Riley
- Respiratory Therapy Area Unit, GlaxoSmithKline Medicines Research Centre, GlaxoSmithKline, Stevenage, Hertfordshire, UK
| | - Sadhana Patel
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, Middlesex, UK
| | - Ian Naya
- Respiratory Medicine, GlaxoSmithKline, Brentford, Middlesex, UK
| | - Chris Compton
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, Middlesex, UK
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Ogasawara T, Sakata J, Aoshima Y, Tanaka K, Yano T, Kasamatsu N. Bronchodilator Effect of Tiotropium via Respimat ®Administered with a Spacer in Patients with Chronic Obstructive Pulmonary Disease (COPD). Intern Med 2017; 56:2401-2406. [PMID: 28824055 PMCID: PMC5643165 DOI: 10.2169/internalmedicine.8255-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Among elderly patients with chronic obstructive pulmonary disease (COPD), there are some patients who cannot inhale tiotropium via Respimat® due to poor hand-lung coordination. This study aimed to examine whether or not tiotropium inhalation therapy using Respimat® with a spacer increased the forced expiratory volume in 1 s (FEV1) in patients with COPD. Methods A randomized, crossover, single-center study was conducted in 18 patients with stable COPD. Tiotropium (5 μg) via Respimat® with or without a spacer (AeroChamber®) was administered for 2 weeks. Following a 2-week washout period using a transdermal tulobuterol patch (2 mg per day), participants were then crossed over to the other inhalation therapy with respect to spacer use. The trough FEV1 was measured at every visit using a spirometer. A questionnaire regarding inhalation therapy was administered to patients at the final visit. Results The administration of tiotropium via Respimat® both with and without a spacer significantly increased the trough FEV1 from baseline during each treatment period, with mean differences of 115.0±169.6 mL and 92.8±128.1 mL, respectively. There was no significant difference in the change in the trough FEV1 between the 2 procedures (p=0.66). A total of 86% of patients reported that inhalation using a spacer was not difficult, and more than half also rated both the usage and maintenance of the AeroChamber® as easy. Conclusion Tiotropium inhalation therapy administered via Respimat® using a spacer exerted a bronchodilatory effect similar to that observed with tiotropium Respimat® alone.
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Affiliation(s)
| | - Jun Sakata
- Pharmaceutical Department, Hamamatsu Medical Center, Japan
| | - Yoichiro Aoshima
- Department of Respiratory Medicine, Hamamatsu Medical Center, Japan
| | - Kazuki Tanaka
- Department of Respiratory Medicine, Hamamatsu Medical Center, Japan
| | - Toshiaki Yano
- Department of Respiratory Medicine, Hamamatsu Medical Center, Japan
| | - Norio Kasamatsu
- Department of Respiratory Medicine, Hamamatsu Medical Center, Japan
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Zhou Y, Zhong NS, Li X, Chen S, Zheng J, Zhao D, Yao W, Zhi R, Wei L, He B, Zhang X, Yang C, Li Y, Li F, Du J, Gui J, Hu B, Bai C, Huang P, Chen G, Xu Y, Wang C, Liang B, Li Y, Hu G, Tan H, Ye X, Ma X, Chen Y, Hu X, Tian J, Zhu X, Shi Z, Du X, Li M, Liu S, Yu R, Zhao J, Ma Q, Xie C, Li X, Chen T, Lin Y, Zeng L, Ye C, Ye W, Luo X, Zeng L, Yu S, Guan WJ, Ran P. Tiotropium in Early-Stage Chronic Obstructive Pulmonary Disease. N Engl J Med 2017; 377:923-935. [PMID: 28877027 DOI: 10.1056/nejmoa1700228] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with mild or moderate chronic obstructive pulmonary disease (COPD) rarely receive medications, because they have few symptoms. We hypothesized that long-term use of tiotropium would improve lung function and ameliorate the decline in lung function in patients with mild or moderate COPD. METHODS In a multicenter, randomized, double-blind, placebo-controlled trial that was conducted in China, we randomly assigned 841 patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 (mild) or 2 (moderate) severity to receive a once-daily inhaled dose (18 μg) of tiotropium (419 patients) or matching placebo (422) for 2 years. The primary end point was the between-group difference in the change from baseline to 24 months in the forced expiratory volume in 1 second (FEV1) before bronchodilator use. Secondary end points included the between-group difference in the change from baseline to 24 months in the FEV1 after bronchodilator use and the between-group difference in the annual decline in the FEV1 before and after bronchodilator use from day 30 to month 24. RESULTS Of 841 patients who underwent randomization, 388 patients in the tiotropium group and 383 in the placebo group were included in the full analysis set. The FEV1 in patients who received tiotropium was higher than in those who received placebo throughout the trial (ranges of mean differences, 127 to 169 ml before bronchodilator use and 71 to 133 ml after bronchodilator use; P<0.001 for all comparisons). There was no significant amelioration of the mean (±SE) annual decline in the FEV1 before bronchodilator use: the decline was 38±6 ml per year in the tiotropium group and 53±6 ml per year in the placebo group (difference, 15 ml per year; 95% confidence interval [CI], -1 to 31; P=0.06). In contrast, the annual decline in the FEV1 after bronchodilator use was significantly less in the tiotropium group than in the placebo group (29±5 ml per year vs. 51±6 ml per year; difference, 22 ml per year [95% CI, 6 to 37]; P=0.006). The incidence of adverse events was generally similar in the two groups. CONCLUSIONS Tiotropium resulted in a higher FEV1 than placebo at 24 months and ameliorated the annual decline in the FEV1 after bronchodilator use in patients with COPD of GOLD stage 1 or 2. (Funded by Boehringer Ingelheim and others; Tie-COPD ClinicalTrials.gov number, NCT01455129 .).
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Affiliation(s)
- Yumin Zhou
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Nan-Shan Zhong
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Xiaochen Li
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Shuyun Chen
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Jinping Zheng
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Dongxing Zhao
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Weimin Yao
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Rongchang Zhi
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Liping Wei
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Bingwen He
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Xiangyan Zhang
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Changli Yang
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Ying Li
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Fenglei Li
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Juan Du
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Jianping Gui
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Bin Hu
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Chunxue Bai
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Ping Huang
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Gang Chen
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Yongjian Xu
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Changzheng Wang
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Biao Liang
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Yinhuan Li
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Guoping Hu
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Hui Tan
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Xianwei Ye
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Xitao Ma
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Yan Chen
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Xiwei Hu
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Jia Tian
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Xiaodan Zhu
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Zhe Shi
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Xiufang Du
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Minjing Li
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Shengming Liu
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Ronghuan Yu
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Jianping Zhao
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Qianli Ma
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Canmao Xie
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Xiongbin Li
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Tao Chen
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Yingxiang Lin
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Lizhen Zeng
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Changxiu Ye
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Weishu Ye
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Xiangwen Luo
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Lingshan Zeng
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Shuqing Yu
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Wei-Jie Guan
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
| | - Pixin Ran
- From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China
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Cai HD, Hou J, Lyu YN, Xiong L, Lu MZ, Wu SL. [Efficacy and safety of tiotropium Respimat in the treatment of chronic obstructive pulmonary disease: systematic review]. Zhonghua Jie He He Hu Xi Za Zhi 2017; 40:596-603. [PMID: 28810313 DOI: 10.3760/cma.j.issn.1001-0939.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: To evaluate the efficacy and safety of tiotropium Respimat in the treatment of chronic obstructive pulmonary disease (COPD) according to the Cochrane systematic evaluation. Methods: The Cochrane Library, PubMed, EMbase, CNKI, VIP and CBM, Wanfang Data were searched(from the foundation date to Jan. 2016) for the randomized controlled trials (RCTs) of tiotropium Respimat in the treatment of patients with COPD. Two reviewers independently retrieved the RCTs according to the inclusion and exclusion criteria, assessed the methodological quality of the included trials.and performed statistical analysis on the data using RevMan 5.3 software. Results: Totally 11 RCTs on efficacy were finally included.The results of the combined analysis showed that FEV(1) was significantly improved in the tiotropium Respimat group than that in the placebo group[MD=0.12, 95%CI(0.10-0.14), P<0.000 01], while FEV(1) was similar between the tiotropium Respimat group and the tiotropium HandiHaler group[5 μg: MD=0.00, 95%CI(-0.04-0.04), P=0.94; 2.5 μg: MD=-0.04, 95%CI(-0.10-0.01), P=0.12; 10 μg: MD=0.02, 95%CI(-0.06-0.09), P=0.66]. FVC was significantly improved in the tiotropium Respimat group than that in the placebo group[MD=0.18, 95%CI(0.09-0.28), P=0.0002], while FVC was similar between the tiotropium Respimat group and the HandiHaler group[2.5 μg: MD=-0.06, 95%CI(-0.16-0.04), P=0.24; 5 μg: MD=-0.00, 95%CI(-0.08-0.08), P=1.00; 10 μg: MD=0.02, 95%CI(-0.14-0.19), P=0.78]. The risk of acute exacerbations was lower in the tiotropium Respimat group (5 μg / kg) than in the placebo group [OR=0.72, 95%CI(0.60-0.86), P=0.000 3]. It was similar in the tiotropium Respimat group (5 μg) and the HandiHaler group[OR=1.01, 95%CI(0.94-1.09), P=0.71]. The SGRQ total score of the tiotropium Respimat group (5 μg) was significantly different from that of the placebo group[MD=-3.6, 95%CI(-3.88--3.32), P<0.000 01]. C(max, ss) and AUC(0-6 h, ss) were also similar between the tiotropium Respimat group and the HandiHaler group[MD=0.2, 95%CI(-5.1-5.5), P=0.94]; MD=-1.01, 95%CI(-11.78-9.77), P=0.85]. Nine RCTs were included in the evaluation of the incident rates of adverse drug reactions(ADR). There was no significant difference between the tiotropium Respimat group HandiHaler group and the placebo group[RR=0.95, 95%CI(0.89-1.00), P=0.05], [OR=1.07, 95%CI(1.00-1.16), P=0.06]. Conclusions: The efficacy and safety of tiotropium Respimat was similar to tiotropium HandiHaler in the treatment of COPD. They can effectively improve the pulmonary function and clinical symptoms of patients. But the long-term efficacy and safety of tiotropium Respimat still need to be confirmed by higher quality and larger RCTs with long-term follow-up.
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Affiliation(s)
- H D Cai
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Beier J, Mroz R, Kirsten AM, Chuecos F, Gil EG. Improvement in 24-hour bronchodilation and symptom control with aclidinium bromide versus tiotropium and placebo in symptomatic patients with COPD: post hoc analysis of a Phase IIIb study. Int J Chron Obstruct Pulmon Dis 2017; 12:1731-1740. [PMID: 28652725 PMCID: PMC5476673 DOI: 10.2147/copd.s121723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A previous Phase IIIb study (NCT01462929) in patients with moderate to severe COPD demonstrated that 6 weeks of treatment with aclidinium led to improvements in 24-hour bronchodilation comparable to those with tiotropium, and improvement of symptoms versus placebo. This post hoc analysis was performed to assess the effect of treatment in the symptomatic patient group participating in the study. METHODS Symptomatic patients (defined as those with Evaluating Respiratory Symptoms [E-RS™] in COPD baseline score ≥10 units) received aclidinium bromide 400 μg twice daily (BID), tiotropium 18 μg once daily (QD), or placebo, for 6 weeks. Lung function, COPD respiratory symptoms, and incidence of adverse events (AEs) were assessed. RESULTS In all, 277 symptomatic patients were included in this post hoc analysis. Aclidinium and tiotropium treatment improved forced expiratory volume in 1 second (FEV1) from baseline to week 6 at all time points over 24 hours versus placebo. In addition, improvements in FEV1 from baseline during the nighttime period were observed for aclidinium versus tiotropium on day 1 (aclidinium 157 mL, tiotropium 67 mL; P<0.001) and week 6 (aclidinium 153 mL, tiotropium 90 mL; P<0.05). Aclidinium improved trough FEV1 from baseline versus placebo and tiotropium at day 1 (aclidinium 136 mL, tiotropium 68 mL; P<0.05) and week 6 (aclidinium 137 mL, tiotropium 71 mL; P<0.05). Aclidinium also improved early-morning and nighttime symptom severity, limitation of early-morning activities, and E-RS Total and domain scores versus tiotropium (except E-RS Chest Symptoms) and placebo over 6 weeks. Tolerability showed similar incidence of AEs in each arm. CONCLUSION In this post hoc analysis of symptomatic patients with moderate to severe COPD, aclidinium 400 μg BID provided additional improvements compared with tiotropium 18 μg QD in: 1) bronchodilation, particularly during the nighttime, 2) daily COPD symptoms (E-RS), 3) early-morning and nighttime symptoms, and 4) early-morning limitation of activity.
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Affiliation(s)
- Jutta Beier
- insaf Respiratory Research Institute, Wiesbaden, Germany
| | - Robert Mroz
- Centrum Medycyny Oddechowej
- Medical University of Białystok, Białystok, Poland
| | - Anne-Marie Kirsten
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
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Trotta F, Spila-Alegiani S, Da Cas R, Rajevic M, Conti V, Venegoni M, Rossi M, Traversa G. Cardiovascular safety of tiotropium Respimat vs HandiHaler in the routine clinical practice: A population-based cohort study. PLoS One 2017; 12:e0176276. [PMID: 28430820 PMCID: PMC5400270 DOI: 10.1371/journal.pone.0176276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/07/2017] [Indexed: 01/08/2023] Open
Abstract
The cardiovascular safety of tiotropium Respimat formulation in the routine clinical practice is still an open issue. Our aim was to compare the risk of acute myocardial infarction and heart rhythm disorders in incident users of either tiotropium Respimat or HandiHaler. The study population comprises patients aged ≥45 years, resident in two Italian regions with a first prescription of tiotropium (HandiHaler or Respimat) between 01/07/2011-30/11/2013. The cohort was identified through the database of prescriptions reimbursed by the Italian National Health Service. Comorbidities and clinical outcomes were obtained from hospital records. The primary outcome was the first hospitalization for acute myocardial infarction and/or for heart rhythm disorders during the exposure period. Hazard ratios were estimated in the propensity score-matched groups through Cox regression. After matching, 31,334 patients with incident prescription of tiotropium were included. The two groups were balanced with regard to baseline characteristics. Similar incidence rates of the primary outcome between Respimat and HandiHaler users were identified (adjusted hazard ratio 1.02, 95% CI 0.82–1.28). No risk difference between Respimat and HandiHaler emerged when considering clinical events separately. This large cohort study showed a comparable acute cardiovascular safety profile of the two tiotropium formulations.
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Affiliation(s)
- Francesco Trotta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Stefania Spila-Alegiani
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Rome, Italy
- * E-mail:
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Rome, Italy
| | - Maja Rajevic
- PhD Course, Pharmaceutical Sciences, Drug Chemistry and Technologies Department, “La Sapienza” University of Rome, Rome, Italy
| | - Valentino Conti
- Regional Center for Pharmacovigilance, General Directorate for Health, The Lombardy Region, Milan, Italy
| | - Mauro Venegoni
- Regional Center for Pharmacovigilance, General Directorate for Health, The Lombardy Region, Milan, Italy
| | - Mariangela Rossi
- Unit for Pharmaceutical Governance, General Directorate for Health, Umbria Region, Perugia, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Rome, Italy
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Sauer R, Griff S, Blau A, Franke A, Mairinger T, Grah C. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia diagnosed by transbronchial lung cryobiopsy: a case report. J Med Case Rep 2017; 11:95. [PMID: 28385164 PMCID: PMC5383988 DOI: 10.1186/s13256-017-1254-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Micronodular lesions are common findings in lung imaging. As an important differential diagnosis, we describe a case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia; it is notable that the diagnosis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is often delayed. This case provides supporting evidence to establish lung biopsy by cryotechnique as the option of first choice when considering a diagnostic strategy for micronodular lung lesions. CASE PRESENTATION We report a case of a 65-year-old white woman who presented with obstructive symptoms of chronic coughing and dyspnea confirmed by conventional lung function tests. A computed tomography scan presented disseminated micronodules in all the lobes of her lungs. With the help of bronchoscopic cryobiopsy it was possible to obtain a high yield sample of lung parenchyma. On histologic examination, the micronodules correlated with a diffuse neuroendocrine cell hyperplasia. In the context of clinical symptoms, radiological aspects, and histomorphological aspects we made the diagnosis of a diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Obstructive symptoms were treated with inhaled steroids and beta-2-mimetics continuously. A comparison between current computed tomography scans of our patient and scans of 2014 revealed no significant changes. Last ambulatory checks occurred in January and May of 2016. The course of disease and the extent of limitation of lung function have remained stable. CONCLUSIONS The diagnosis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia is best made in a multidisciplinary review including clinical presentation, lung imaging, and histomorphological aspects. This report and current literature indicate that transbronchial lung cryobiopsy can be used as a safe and practicable tool to obtain high quality biopsies of lung parenchyma in order to diagnose micronodular lesions of the lung.
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Affiliation(s)
- R. Sauer
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Walterhöferstr. 11, Berlin, 14165 Germany
| | - S. Griff
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Walterhöferstr. 11, Berlin, 14165 Germany
| | - A. Blau
- Department of Respiratory Medicine, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - A. Franke
- Group Practice of Respiratory Medicine, Klosterstraße 34/35, Berlin, Germany
| | - T. Mairinger
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Walterhöferstr. 11, Berlin, 14165 Germany
| | - C. Grah
- Department of Respiratory Medicine, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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