Effect of Peri-operative Bronchodilator Therapy on Postoperative Pulmonary Function among Lung Cancer Patients with COPD

초록

COPD is the most frequent concomitant disease in early-stage NSCLC patients. However, substantial portion of COPD patients in these patients are under-diagnosed and under-treatment. There is limited research examining the short-term and long-term effectiveness of perioperative bronchodilators in patients with COPD patients who underwent surgical resection for NSCLC. The data were obtained from a retrospective cohort with NSCLC patients who underwent curative intent surgical resection at Samsung Medical Center, Seoul, Korea between January 2016 and December 2018. We identified 290 subjects who had COPD (defined as pre-bronchodilator FEV1/FVC < 0.70 and FEV1 < 80%) wand had spirometry results postoperative periods between 3-month and 12-month. The primary outcome was the change of FEV1 based on the use of perioperative bronchodilator. Only 53% of COPD patients used bronchodilators during perioperative periods. Compared with bronchodilator group, non-bronchodilator group showed greater degree of lung function decline at 1, 4 and 12 months after surgery, even after adjustment for major confounders including surgical extent, VATS, and preoperative lung function (adjusted mean difference in FEV1 decline from baseline; -202 mL, 95% CI [-267, -136]; -199 mL, 95% CI [-282, -166]; -200 mL, 95% CI [-281, -118] at 1, 4, and 12 months after surgery, respectively). Perioperative treatment with bronchodilators in COPD patients obtained benefits to alleviate reduction of lung function, in particular, FEV1. The active diagnosis of COPD and use of bronchodilators are required for NSCLC patients who were scheduled to undergo surgical resection.

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