Abstract
BACKGROUND: Many studies explored the features of Chronic obstructive pulmonary disease (COPD) with asthma-like features. We aimed to compare the exacerbation and mortality during one-year follow-up among COPD patients with asthma-like features with different inhalation therapies in the Chinese population (compare Without-inhaled corticosteroids(ICS)and With-ICS inhalation therapy, and then ICS + long-acting β-2-agonist(LABA) and ICS + LABA + long-acting muscarinic antagonists (LAMA). METHODS: This real-world observational study was conducted in the RealDTC cohort (ChiCTR-POC-17010431, Trial Regisrtation Date: 2017.01.14). COPD patients with asthma-like features in China from July 1, 2017, to June 31 2022 were recruited into the study and followed-up for 12 months. The Without-ICS inhalation therapy cohort included patients with LAMA or LABA + LAMA therapy, the With-ICS inhalation therapy cohort included patients with ICS + LABA or ICS + LABA + LAMA therapy. RESULTS: Of the 2735 eligible participants, the With-ICS inhalation therapy cohort was less likely to experience moderate-to-severe exacerbation and severe exacerbation during follow-up than the Without-ICS inhalation therapy cohort after PSM in multivariate analysis, but not death. The ICS + LABA + LAMA group had a lower risk of moderate-to-severe and frequent exacerbations than the ICS + LABA group after PSM. In addition, patients with CAT ≥ 10, or with previous exacerbation history, or with GOLD II and GOLD III + IV grade, receiving ICS + LABA + LAMA had a decreased risk of exacerbation compared to ICS + LABA. CONCLUSIONS: COPD patients with asthma-like features with With-ICS inhalation therapy based on bronchodilators were less likely to experience future exacerbations than those Without-ICS inhalation therapy, but not death. In addition, ICS + LABA + LAMA therapy decreased the risk of exacerbation compared to ICS + LABA therapy during follow-up, especially in patients with CAT ≥ 10, or with previous exacerbation history, or with GOLD II and GOLD III + IV grade.