Preoperative umeclidinium/vilanterol or tiotropium improves postoperative FEV(1) in lung cancer patients with comorbid untreated chronic obstructive pulmonary disease

BACKGROUND: This study aimed to examine the effects of preoperative interventions in lung cancer patients with untreated chronic obstructive pulmonary disease (COPD). We evaluated the efficiency of preoperative interventions using tiotropium (TIO) or umeclidinium/vilanterol (UMEC/VI). METHODS: We conducted a two-center retrospective study. Perioperative forced expiratory volume in 1 second (FEV(1)) was compared between a preoperative COPD intervention group and an untreated group. COPD therapeutic drugs were started 2 weeks before surgery and were continued until 3 months after surgery. Radical lobectomy was performed in patients with an FEV(1) of ≥1.5 L. RESULTS: A total of 92 patients were enrolled (untreated, 31 patients; intervention, 61 patients). In the intervention group, 45 (73.8%) patients were prescribed the UMEC/VI intervention and 16 (26.2%) received TIO. The intervention group showed a greater increase in FEV(1) than the untreated group (FEV(1): 120 vs. 0 mL, P=0.014). In the intervention group, the UMEC/VI group showed a greater increase in FEV(1) than the TIO group (FEV(1): 160 vs. 7 mL, P=0.0005). In 9 of 15 (60.0%) patients with an FEV(1) of <1.5 L before intervention, FEV(1) increased to ≥1.5 L after intervention. Postoperative FEV(1) in the intervention group was similar to that before intervention, unlike in the untreated group (−0.05 vs. −0.25 mL, P=0.0026). Moreover, the FEV(1) in the untreated group was similar to the preoperative predicted value, whereas that in the intervention group was significantly higher than the predicted value (+0.33 vs. +0.04 mL, P<0.0001). CONCLUSIONS: In lung cancer patients with untreated COPD, active preoperative intervention improved respiratory function, expanded treatment options, and maintained respiratory function to a degree that exceeded preoperative predictions.