Effects of inhaled corticosteroid/long-acting β2-agonist combination on the airway microbiome of patients with chronic obstructive pulmonary disease: A randomized controlled clinical trial (DISARM)
- Authors
- Leitao, Filho Fernando Sergio; Takiguchi, Hiroto; Akata, Kentaro; Ra, Seung Won; Moon, Ji-Yong; Kim, Hyun Kuk; Cho, Yuji; Yamasaki, Kei; Milne, Stephen; Yang, Julia; Tony, Yang Cheng Wei; Li, Xuan; Nislow, Corey; van, Eeden Stephan F; Shaipanich, Tawimas; Lam, Stephen; Leung, Janice M.; Sin, Don D.
- Issue Date
- Nov-2021
- Publisher
- American Thoracic Society
- Keywords
- COPD; inhaled corticosteroids; airway microbiome; 16S rRNA gene
- Citation
- American Journal of Respiratory and Critical Care Medicine, v.204, no.10, pp.1143 - 1152
- Indexed
- SCIE
SCOPUS
- Journal Title
- American Journal of Respiratory and Critical Care Medicine
- Volume
- 204
- Number
- 10
- Start Page
- 1143
- End Page
- 1152
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/138610
- DOI
- 10.1164/rccm.202102-0289OC
- ISSN
- 1073-449X
- Abstract
- Rationale: Inhaled corticosteroids (ICS) are commonly prescribed with long-acting b2-agonists (LABA) in chronic obstructive pulmonary disease (COPD). To date, the effects of ICS therapy on the airway microbiome in COPD are unknown. Objectives: To determine the effects of ICS/LABA on the airway microbiome of patients with COPD. Methods: Clinically stable patients with COPD were enrolled into a 4-week run-in period during which ICS was discontinued and all participants were placed on formoterol (Form) 12 mg twice daily (BID). The participants were then randomized to budesonide/ formoterol (Bud 1 Form; 400/12 mg BID), fluticasone/salmeterol (Flu 1 Salm; 250/50 mg BID), or formoterol only (12 mg BID) for 12 weeks. Participants underwent bronchoscopy before and after the 12-week treatment period. The primary endpoint was the comparison of changes in the airway microbiome over the trial period between the ICS/LABA and LABA-only groups. Measurements and Main Results: Sixty-three participants underwent randomization: Bud 1 Form (n = 20), Flu 1 Salm (n = 22), and Form (n = 21) groups; 56 subjects completed all visits. After the treatment period, changes in a-diversity were significantly different across groups, especially between Flu 1 Salm and Form groups (Drichness: P = 0.02; DShannon index: P = 0.03). Longitudinal differential abundance analyses revealed more pronounced microbial shifts from baseline in the fluticasone (vs. budesonide or formoterol only) group. Conclusions: Fluticasone-based ICS/LABA therapy modifies the airway microbiome in COPD, leading to a relative reduction in a-diversity and a greater number of bacterial taxa changes. These data may have implications in patients who develop pneumonia on ICS. Clinical trial registered with www.clinicaltrials.gov (NCT02833480).
- Files in This Item
-
Go to Link
- Appears in
Collections - 서울 의과대학 > 서울 내과학교실 > 1. Journal Articles
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.