Preoperative use of long-acting muscarinic antagonist (LAMA) with a long-acting β2 agonist (LABA) was associated with significant improvements in lung function and fewer postoperative complications compared with use of LAMA alone in patients with lung cancer and chronic obstructive pulmonary disease (COPD), according to study results published in BMC Pulmonology Medicine.
The study was a retrospective review and analysis of 130 consecutive patients with newly diagnosed COPD who underwent surgery for lung cancer between 2005 and 2019. Patients received perioperative rehabilitation and were divided into 3 groups based on perioperative inhaled therapy and management received, including a combination regimen comprising LAMA/LABA (n=64), LAMA only (n=23), and rehabilitation only with no bronchodilator (n=43).
According to a review of the patients’ medical records, those who received LAMA/LABA therapy prior to surgery had significant preoperative improvements in lung function as assessed by forced expiratory volume in 1 second (FEV1) and FEV1 percent predicted (P <.001 for both). Patients who received preoperative LAMA/LABA therapy also had significantly improved lung function compared with those who received LAMA therapy only (ΔFEV1: 223.1 mL vs 130.0 mL, respectively; ΔFEV1 percent predicted: 10.8% vs 6.8%; P <.05 for both). Additionally, the study authors found significantly fewer postoperative complications in the group of patients who received LAMA/LABA vs LAMA alone (P =.007).
In a subgroup of 61 patients with moderate to severe air flow limitation, patients who received the combination regimen consisting of LAMA/LABA had significantly longer overall survival and disease-free survival compared those who received LAMA alone (P =.049 [95% CI, 0.08-0.98]; P =.026 [95% CI, 0.11-0.90]) and rehabilitation only (P =.001 [95% CI, 0.53]; P <.001 [95% CI, 0.04-0.45]).
The study authors also observed significantly lower rates of recurrence among patients who received perioperative LAMA/LABA therapy (P =.006) and rehabilitation only (P =.008).
Limitations of this study included its retrospective nature as well as its duration, as potential changes in surgical techniques and use of anesthetic agents over the study period could have had an impact on the postoperative complications.
Based on their findings, the authors wrote that “perioperative combined LAMA/LABA therapy is the optimal bronchodilator for patients with COPD who require surgery for lung cancer.”
Azuma Y, Sano A, Sakai T, et al. Prognostic and functional impact of perioperative LAMA/LABA inhaled therapy in patients with lung cancer and chronic obstructive pulmonary disease. BMC Pulm Med. 2021;21(1):174. doi:10.1186/s12890-021-01537-z