Possibilities of combined bronchodilator therapy in the complex treatment of patients with comorbid pathology: focusing on patients with newly diagnosed tuberculosis and chronic obstructive pulmonary disease

Background. Chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis (TB) are socially significant diseases with a high socio-economic burden. The combination of these diseases in one patient increases the likelihood of their mutual complication, which determines the importance of using effective and safe therapy for each of them to improve the results of their treatment. Objective. A comparative analysis of the effectiveness of using tiotropium bromide and olodaterol/tiotropium as supporting therapy for the correction of broncho-obstructive syndrome in patients with TB+COPD comorbid pathology. Methods. A prospective comparative study included 62 patients with TB + COPD aged 18 to 75 years, Me (25; 75) 58.0 (48.0; 65.0) years. 56 (90.3±3.8%) patients were diagnosed with Infiltrative TB, 3 (4.8±2.7%) patients - focal TB, 2 (3.2±2.2%) patients - fibrocavernous TB, and 1 (1.6±1.6%) patient - with disseminated TB. COPD: category B - 41 (66.1±6.0%), C - 6 (9.7±3.8%), D - 15 (24.2±5.4%) patients; there were no category A patients among included in the study. Patients were divided into 2 groups: group 1 (n=31) along with TB chemotherapy received DDAC (tiotropium bromide - Tb in handichaler and respimat) 18 pg/day or 2.5 pg 2 doses once a daY., group 2 (n=31) received LAAC/LABA (tiotropium bromide/olodaterol - Tb/O in the respimat) 2.5/2.5 pg 2 doses once a day. Results. There was a positive trend in the severity of dyspnea, CAT tesT., spirometry indicators in the both observation groups. Against the background of use of each drug, a statistically significant decrease in dyspnea according to the MRC scale was achieved in 3 months; by 1 point on from 3.0 to 2.0 points against the background of LAAC (Tb) (Z=2.19; P=0.000) and LAAC/LABA (Tb/O) (Z=3.92; P=0.000), respectively. The increase in FEV1, 1 l for 3 months of therapy with LAAC (Z=3.81; P=0.000) and LAAC/LABA (Z=4.70; P=0.000) per 300 ml in groups, respectively. According to the CAT tesT., a statistically significant benefit in favor of the combined bronchodilator LAAC/LABA was obtained (in group 1, a decrease to 10 points, in group 2 - to 12 points [Z=2.013; P=0.044]). The efficacy of TB therapY., assessed by smear negative reaction after 6 months of follow-up: 88.2% of cases in group 1 (LAAC) versus 94.1% in group 2 (LAAC/LABA), respectively (x2=2.22; P=0.528), cessation of bacterial excretion: 77.8 and 80.0% in groups 1 and 2, respectively (X2=0.608; P=0.896), and closure of decay cavities: 66.7 and 65% in groups 1 and 2 (x2=0.207; P=0.977) was higher in patients receiving combined bronchodilator therapy with LAAC/ LABA. Conclusion. The use of the Tb/O (Spiolto Respimat) 2.5/2.5, combined LAAC/LABA drug with a long 24-hour action, in the complex therapy of broncho-obstructive syndrome in patients with TB+COPD is effective and reasonable, because allows not only to improve the general condition of patients, but also to increase the effectiveness and reduce the duration of TB treatment by increasing treatment adherence.

chronic obstructive pulmonary disease, pulmonary tuberculosis, treatmenT, long-actingß2-agonists, long-acting M-anticholinergics