The Korean Academy of Tuberculosis and Respiratory Diseases
420 32nd World Congress of Internal Medicine (October 24-28, 2014)
OS-040 COPD
Discrepancy Between CAT and mMRC in Korean COPD Patients
Chin Kook Rhee1, Hyoung Kyu Yoon2, Kwang Ha Yoo3, Ki-Suck Jung4
The Catholic University of Korea, Seoul St. Mary`s Hospital, Korea1, The Catholic University of Korea, Yeouido St. Mary`s Hospital, Korea2, Konkuk University School of Medicine, Korea3, Hallym University Sacred Heart Hospital, Korea4
Background: The GOLD consensus uses symptoms to categorize patients according to disease severity and guide treatment. COPD Assessment Test (CAT) and modifi ed Med- ical Research Council (mMRC) are both used to evaluate the symptoms. The purpose of this study is to examine the discrepancy between CAT and mMRC in patients with COPD.
Methods: Patients were recruited from 50 centers in Korea, as part of the Korean COPD Study Group (KOCOSS) cohort.
Results: Total 882 patients with COPD were eligible for analysis. Age was 71.1 ± 7.8 (Mean ± SD) and 90.8 % were male. Post bronchodilator FVC, FEV1, and FEV1/
FVC were 81.7 ± 17.6 %, 55.7 ± 16.7 %, and 49.0 ± 12.0 %. Mean CAT, mMRC, and SGRQ-c score was 15.6 ± 7.8, 1.6 ± 1.0, and 35.0 ± 19.7. There was signifi cant corre- lation between CAT and mMRC (R = 0.49, P < 0.01), SGRQ-c and mMRC (R = 0.57, P
< 0.01), and CAT and SGRQ-c (R = 0.74, P < 0.01). However, mMRC was less than 2 in 53.3 % of patients while CAT was less than 10 in only 23.3 % of patients. By using ROC curve, CAT score 15 (Sensitivity: 0.70, Specifi city: 0.66, AUC: 0.74 (0.71 - 0.77, 95% CI)) and SGRQ-c 31.3 (Sensitiviity: 0.72, Specifi city: 0.74, AUC: 0.79 (0.76 - 0.82, 95% CI)) were compatible with mMRC 2. The kappa value for the GOLD distrubution between CAT 10 and mMRC 2 was 0.473. Kappa between CAT 10 and mMRC 1 was 0.659 and CAT 15 and mMRC 2 was 0.561
Conclusions: Although there was correlation between CAT and mMRC, discrepancy between two scores was noted. Further study regarding CAT and mMRC in patients with COPD is needed.
OS-041 COPD
Clinical Effi cacy and Adverse Events Between
Indacaterol and Tiotropium in COPD: Meta-Analysis of Randomized Controlled Trials
Jung Soo Kim1, Hye Yun Park1, Yeon-Mok Oh2, Kwang Ha Yoo3, Yong Bum Park4, SeungSoo Sheen5, Jinkyeong Park6, Ji Ye Jung7, Seong Yong Lim8
Samsung Medical Center, Korea1, Samsung Medical Center, Korea2, Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Korea3, Division of Pulmonology, Allergy & Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Korea4, Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Korea5, Department of Pul- monary and Critical Care Medicine Wonkwang University, Sanbon Hospital, Korea6, Division of Pulmon- ology, Department of Internal Medicine, Institute of Chest Disease, Yonsei University College of Medicine, Korea7, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea8
Background: Current guidelines recommend the use of inhaled long-acting broncho- dilators as the fi rst-line therapy in patients with stable chronic obstructive pulmonary disease (COPD). In Korea, nationally, two, once daily inhaled bronchodilator are avail- able: the beta2 agonist indacaterol and the anticholinergic tiotropium. We aimed to compare the clinical effi cacy and safety between indacaterol and tiotropium.
Methods: Data sources were Medline, EMBASE, Cochrane Central Register of Con- trolled Trials (to July, 2014). Randomized prospective trials that compared tiotropium with indacaterol in COPD for more than 12 weeks were included. The primary outcome was trough FEV1 at 12th week, and secondary outcomes included trough FEV1 at 26th week, St. George`s Respiratory Questionnaire (SGRQ) total score at 26th week, and adverse events.
Results: Four RCTs were eligible for inclusion. Trough FEV1 at 12th and 26th week were not significantly different between tiotropium and indacaterol by a standard deviation mean difference (SMD) of 0.00 (95% CI: -0.01, 0.02, I2 =12%) and 0.02 (95%
CI: -0.07, 0.12,I2 = 0%), respectively. Regarding to quality of life, indacaterol and ti- otropium showed similar SGRQ total score at 26th week (SMD of -0.01, 95% CI: -0.07,
0.08, I2 = 50%). Adverse events such as cardiovascular event and nasopharyngitis, and serious adverse events were similar between indacaterol and tiotropium, while cough was more common in indacaterol than tiotropium (OR: 1.65, 95% CI 1.33, 2.06).
Conclusions: The evidence is equivocal as to clinical efficacy and serious adverse events between tiotropium and indacaterol, while patients with indacaterol had com- plained for cough more than those with tiotropium.
OS-042 COPD
Risk Factors for Discontinuation of Rofl umilast in COPD Patients
Chin Kook Rhee1, Kyung Hoon Kim1, Hyoung Kyu Yoon2
The Catholic University of Korea, Seoul St. Mary`s Hospital, Korea1, The Catholic University of Korea, Yeouido St. Mary`s Hospital, Korea2
Background: Roflumilast is PDE4 inhibitor, which can decrease exacerbation in patients with COPD. However, adverse effect is a major barrier to use medication.
However, little is known regarding the risk factors for discontinuation of rofl umilast in COPD patients.
Methods: Patients who administrated rofl umilast in Seoul St. Mary’s Hospital during December 2012 and June 2014 were enrolled.
Results: During the study period, 157 patients administrated rofl umilast. Male was 93.0% and mean age was 70.1 ± 9.9 (mean ± SD). Mean post bronchodilator FVC (%), FEV1 (%), and FEV1/FVC (%) were 77.2 ± 20.6, 46.4 ± 16.4, and 43.2 ± 13.8. Among them, 53 (33.8%) patients discontinued rofl umilast because of adverse effect. In uni- variative analysis, never smoker was signifi cantly higher in patients who discontinued rofl umilast (15.4% vs 5.1%). BMI was signifi cantly lower in patients who discontinued rofl umilast (21.0 vs 22.7). In multivariative analysis, low BMI and never smoker were both signifi cant factors for discontinuation of rofl umilast. Odd ratio of BMI (1 unit decrease) was 1.14 (95% CI: 1.03 - 1.27, P = 0.011) and never smoker was 3.66 (1.09 - 12.29, P = 0.036).
Conclusions: Never smoker and low BMI were signifi cant factors for discontinuation of rofl umilast in patients with COPD.
