Prognostic and functional impact of perioperative LAMA/LABA inhaled therapy in patients with lung cancer and chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting (2) agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients. METHODS: Between January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical record to evaluate that LAMA/LABA might be an optimal regimen for patients with COPD undergoing surgery for lung cancer. All patients were received perioperative rehabilitation and divided into 3 groups according to the type of perioperative inhaled therapy and management: LAMA/LABA (n=64), LAMA (n=23) and rehabilitation only (no bronchodilator) (n=43). We conducted a retrospective review of their medical records. RESULTS: Patients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p<0.001 for both forced expiratory volume in 1s (FEV(1)) and percentage of predicted forced expiratory volume in 1s (FEV(1)%pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (FEV(1), LAMA/LABA 223.1mL vs. LAMA 130.0mL, FEV(1)%pred, LAMA/LABA 10.8% vs. LAMA 6.8%; both p<0.05). Postoperative complications were lower frequent in the LAMA/LABA group than in the LAMA group (p=0.007). In patients with moderate to severe air flow limitation (n=61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with the LAMA (p=0.049, p=0.026) and rehabilitation-only groups (p=0.001, p<0.001). Perioperative LAMA/LABA therapy was also associated with lower recurrence rates (vs. LAMA p=0.006, vs. rehabilitation-only p=0.008). CONCLUSIONS: We believe this treatment combination is optimal for patients with lung cancer and COPD. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-021-01537-z.