Evidence map›Paper›PMID 39420386›Full record

ArticleRespiratory research2024

Benefit of dual bronchodilator therapy on exacerbations in former and current smokers with chronic obstructive pulmonary disease in real-world clinical practice: a multicenter validation study (TOReTO).

Yu-Ting Lai, Ying-Huang Tsai, Meng-Jer Hsieh, Ning-Hung Chen, Shih-Lung Cheng, Chi-Wei Tao, Yu-Feng Wei, Yao-Kuang Wu, Ming-Cheng Chan, Shih-Feng Liu and 5 more

Abstract readMulticenter StudyValidation Study
In one paragraph

Article in Respiratory research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. COPD-Lung Cancer Comorbidity: Mechanistic Insights and Precision Oncology Implications.International journal of chronic obstructive pulmonary disease · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Yu-Ting LaiDivision of Pulmonary Medicine, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
Ying-Huang TsaiDepartment of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan, Taiwan.
Meng-Jer HsiehDepartment of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan, Taiwan.
Ning-Hung ChenDepartment of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan, Taiwan.
Shih-Lung ChengDepartment of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan.
Chi-Wei TaoDepartment of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan.
Yu-Feng WeiSchool of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Yao-Kuang WuDivision of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, New Taipei, Taiwan.
Ming-Cheng ChanDivision of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Shih-Feng LiuDepartment of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Wu-Huei HsuCritical Medical Center, China Medical University Hospital, Taichung, Taiwan.
Tsung-Ming YangDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
Ching-Lung LiuDivision of Chest Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
Ping-Hung KuoDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ming-Shian LinDivision of Pulmonary Medicine, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan. 02456@cych.org.tw.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDual bronchodilator therapy, consisting of a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), has proven effective for patients with chronic obstructive pulmonary disease (COPD). However, it remains uncertain whether there are efficacy differences between current and former smokers with COPD. This study aims to explore the effectiveness of LABA/LAMA therapies in both these groups.

methodsThe TOReTO trial assessed lung function, symptoms, health status, the occurrence of exacerbations, clinically significant exacerbations, and the use of LABA/LAMA therapies. These therapies include Tio/Olo, umeclidinium/vilanterol (Umec/Vi), and umeclidinium/vilanterol (Umec/Vi) are used in patients with COPD. The study examined the differences in outcomes between current and former smokers. To balance the baseline characteristics, propensity score matching (PSM) was employed.

resultsData from 967 patients were collected. After PSM, the time to the first acute exacerbation in current smokers was analyzed separately for the three treatment groups and was significantly different between them (p = 0.0457). Among, there are differences in the occurrence of acute exacerbation between treatment and smoking status in Umec/Vi (p = 0.0114). There is no significant difference in the treatment of former smokers among the three different groups of LABA/LAMA fixed-dose combinations (p = 0.3079). COPD-related symptoms remained stable throughout the treatment period. There were no significant differences in symptom scores, including CAT and mMRC, among the three groups at the end of the study.

conclusionsThe three fixed-dose combinations of LABA/LAMA showed no difference in reducing exacerbations in former smokers but did show differences in current smokers. This trend has clinical significance, and future research will be conducted to control influencing variables to validate this point. However, due to the non-randomized study design, these findings should be interpreted with caution.

Indexed as

Bronchodilator AgentsMuscarinic AntagonistsPulmonary Disease, Chronic ObstructiveSmokersAdrenergic beta-2 Receptor AgonistsAgedDisease ProgressionDrug CombinationsDrug Therapy, CombinationFemaleHumansMaleMiddle AgedQuinuclidinesSmokingTreatment OutcomeAdrenergic beta-2 Receptor AgonistsBronchodilator AgentsDrug CombinationsGSK573719Muscarinic AntagonistsQuinuclidinesCAT scoresChronic obstructive pulmonary diseaseExacerbation ratesFEV1Long-acting beta-agonist (LABA)/long-acting muscarinic antagonist (LAMA)mMRC scores

Identifiers

PMID39420386
PMCPMC11487693

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.