Late-breaking abstract: Outcome of withdrawal of one inhaler in COPD patients received combined ICS/LABA and LAMA

Current COPD guidelines recommend 'triple therapy' with a long acting muscarinic antagonist and a combination of long acting β2-agonists/inhaled corticosteroid in patients with severe to very severe COPD or a history of frequent exacerbations if symptoms are not controlled with either inhaler alone. In the clinical field, withdrawal of either one inhaler in COPD patients receiving triple therapy (step down) often occurs. Our objective was to determine the outcome of step down in Korean Obstructive Lung Disease (KOLD) cohort with retrospectively reviewing the medical records. Triple group was defined patients treated with triple therapy over 2 years(n=109) and Step down group was defined patients treated with triple therapy at least for 1 year and followed over 1 year after withdrawal of either one inhaler(n=39). Index time (IT) was defined as the time point of withdrawal in Step down group or 1 year after the start of triple therapy in Triple group. Baseline demographic data, lung function, and patients reported outcomes at IT were not different between two groups, however, exacerbation frequency of the previous year was significantly lower in Step down group than Triple group (0.36±0.58 vs. 0.78±0.99, p=0.001). Even though, step down occurred in patients with lower exacerbation frequency, step down resulted in aggravating quality of life, decreasing exercise performance, and accelerating FEV1 decline, without increasing the frequency of exacerbation. Eleven patients (28%) in Step down group, re-started discontinued inhaler after 17±8 months. Withdrawing either one inhaler during treated with triple therapy in COPD patients should be done cautiously, which can aggravate patients' condition.