CHEST Guidelines-Response_chest

Response_chest - 3

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The document comprises several pieces of correspondence regarding studies related to chronic obstructive pulmonary disease (COPD) treatment and cardiovascular prevention in sleep apnea patients, published in the medical journal CHEST.<br /><br />The first letter by Brian Lipworth and colleagues discusses a study by Suissa et al. that compared triple therapy using inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), and long-acting muscarinic antagonists (LAMA), with dual therapy using LABA/LAMA in COPD patients. Lipworth highlights that Suissa’s study showed benefits from triple therapy for patients with high eosinophil counts or frequent exacerbations but notes that the study uses data from a time when triple therapy required two inhalers, which might not reflect current practices using single-inhaler therapies. They suggest further analysis could be valuable but understand the limitations due to small sample sizes in this subgroup of patients.<br /><br />In response, Suissa and Ernst acknowledge Lipworth's feedback and limitations due to data collection times and equipment used. They confirm the effectiveness of triple therapy in patients with certain conditions but note challenges in analyzing small sample sizes for combined criteria such as high eosinophil counts and exacerbation frequency. They agree on the value of revisiting these studies with the availability of single inhaler therapies to better understand adherence and effectiveness.<br /><br />The third letter from another set of authors reflects on redesigning studies related to Continuous Positive Airway Pressure (CPAP) treatment for cardiovascular disease prevention. They propose an observational study using propensity score methodologies instead of large-scale randomized controlled trials (RCTs), emphasizing the inclusion of excessively sleepy patients from sleep centers to improve causality and cost-effectiveness, avoiding ethical concerns about withholding potential treatment benefits in randomized settings.<br /><br />Overall, the correspondence emphasizes the importance of evolving study designs to reflect contemporary clinical practices and improve real-world applicability and outcomes in COPD and CPAP therapy research.

Keywords

COPD treatment

cardiovascular prevention

sleep apnea

triple therapy

inhaled corticosteroids

long-acting beta-agonists

long-acting muscarinic antagonists

Continuous Positive Airway Pressure

propensity score methodologies

medical journal CHEST