Researchers supported by the National Institutes of Health discovered that dual bronchodilators – long-lasting inhalers that relax the airways and make it easier to breathe – are of little benefit to people who do not have chronic obstructive pulmonary disease (COPD), but who do have respiratory symptoms and a smoking history.
About 15 million Americans suffer from COPD, a lung condition that obstructs the airways and causes coughing, wheezing, and shortness of breath. However, millions of other smokers or former smokers with COPD symptoms have been administered bronchodilators as well.
MeiLan K. Han, M.D., the study’s primary investigator and first author, stated, “We thought these drugs worked in patients who did not fulfill the lung function criteria for COPD, but we never checked.” Now we know that these present drugs are ineffective for these patients.
The National Heart, Lung, and Blood Institute (NHLBI)-funded study’s findings were published in the New England Journal of Medicine and simultaneously presented at the European Respiratory Society International Congress.
According to scientists, the consequences are substantial. Han stated that spirometry, a lung function test that is underutilized in clinical practice, demonstrates the significance of diagnosing lung problems. Second, they demonstrate the need for novel, effective therapy for COPD-free patients.
She said that inhalers have been the go-to treatment for these individuals for a long time since clinicians either presume a patient has COPD or, if they don’t, that their smoking-related symptoms can be improved by inhalers. Despite the fact that tobacco smoking causes a broad range of lung damage, the study revealed that bronchodilator medication only benefits people with sufficient lung damage to produce aberrant spirometry findings.
In the 12-week, randomized, double-blind study, which was part of the Redefining Therapy in Early COPD for the Pulmonary Trials Cooperative (RETHINC), 535 adults with COPD symptoms, ages 40 to 80, were enrolled at one of 20 U.S. medical sites. Participants used an inhaler containing either medication or a placebo twice daily.
As measured by the St. George’s Respiratory Questionnaire, some individuals in the medicine (intervention) and placebo (control) groups demonstrated small respiratory improvements at the conclusion of the study. This could have meant that they coughed less, generated less phlegm, or felt less winded. The researchers discovered no significant changes between those who received medication and those who received a placebo. 56% (128 of 227) of participants who received the medicine reported improvements in respiratory symptoms, compared to 59% (144 of 244) of those who received the placebo.
According to Han, these findings demonstrate why we cannot continue doing what we’ve been doing, which is not using spirometry and treating COPD patients with the same drugs, and expect change.
Antonello Punturieri, M.D., Ph.D., program director of the Chronic Obstructive Pulmonary Disease/Environment Program at the National Heart, Lung, and Blood Institute, stated that spirometry testing should be administered to all patients who exhibit symptoms of COPD, airflow obstruction, or a history of cigarette smoking. Although spirometry results are used in around one-third of COPD-related physician visits, approximately half of individuals who satisfy the criteria for COPD go misdiagnosed.
Helping patients quit smoking is the most effective method for preventing COPD or COPD-like symptoms, according to the study. According to the Centers for Disease Control and Prevention, more than 30 million Americans smoke, and many who have not been diagnosed with COPD have similar symptoms. About one-quarter of current and past smokers who do not have COPD report experiencing shortness of breath. In addition to encouraging smoking cessation, physicians can assist patients who do not satisfy the lung function requirements for COPD by addressing any other underlying disorders, such as overweight and obesity, heart failure, or other lung problems.
“In the interim,” Han stated, “research should focus on discovering new treatments for them.” “The next question is if we can design more targeted medicines for these patients who have milder symptoms.”
“Because cough and mucus production are prevalent in this patient population, we expect that medicines that target mucus production in the airways may be helpful,” said Prescott G. Woodruff, M.D., the study’s primary investigator and senior author.
Some of these medicines are already under development, and the results of other investigations may shed light on the biological origins of excessive airway mucus. These hints could assist researchers in identifying other treatments.
For additional information on lung health, please visit https://www.nhlbi.nih.gov/BreatheBetter.
Visit https://www.pulmonarytrials.org/ptc-studies/rethinc for information about RETHINC and the Pulmonary Trials Cooperative.
NHLBI: About the National Heart, Lung, and Blood Institute The NHLBI is the global leader in performing and supporting research that enhances scientific knowledge, improves public health, and saves lives in the areas of heart, lung, and blood illnesses and sleep disorders. For additional details, please visit https://www.nhlbi.nih.gov.
About the National Institutes of Health (NIH): The National Institutes of Health (NIH), the nation’s medical research organization, consists of 27 Institutes and Centers and is part of the U.S. Department of Health and Human Services. The NIH is the principal government organization that conducts and supports basic, clinical, and translational medical research and investigates the causes, treatments, and cures for both common and rare diseases. Visit www.nih.gov for more information on the NIH and its initiatives.
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Study
Bronchodilators in symptomatic tobacco-exposed individuals with intact spirometry for the RETHINC study group. Han MK, Ye W, Wang D, et al.
The New England Journal of Medicine, 2022; DOI: 10.1056/NEJMoa220475.