P5 Impact of pharmacotherapy with inhaled corticosteroids and long-acting beta-2 agonists on symptom control and oscillometry parameters among Indian patients with early COPD due to smoking and non-smoking causes: indian pre COPD assessment network (IeCAN) study

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Background Pre-COPD is seen in 6–8% smokers but difficult to diagnose/treat in clinical settings due to normal spirometry. We wished to study whether Oscillometry help identify Pre-COPD and help assess response to treatment. Methods In this 12-week, randomized, double-blind double dummy, placebo-controlled trial across 10 Indian centers, adults aged 35–55 without previous history of or treatment for Asthma, with more than 10 pack years of smoking or equivalent biomass fuel exposure, respiratory symptoms and CAT score>10, normal spirometry, and elevated AX (>6 cmH2O/L) were enrolled. Participants underwent HRCT, received salbutamol inhaler as needed and randomized to once-daily Fluticasone Furoate/Vilanterol or placebo. All smokers were provided smoking cessation advice. Assessments performed at baseline, 6, and 12 weeks included CAT score, spirometry, and oscillometry (using Tremoflo). Results 149 individuals screened, 93 eligible patients were randomized (Active Group: FF/V, n=43; Placebo group, n=50). 34 participants lost to follow-up, data from 59 analyzed (Active 28; Control: 31). Well matched groups with mean age 44, CAT score 15 and median Ax 13.6 cmH2O/L. There was a significant within-group reductions in CAT scores. Between-group difference of 1.7 was not significant (p=0.18). Spirometry showed no significant change. However, oscillometry parameters, (Ax, R5, R5-R20), showed significant improvement in Active group compared to baseline and compared to Placebo (p<0.05, figure 1). Of the 59 participants, 41 were smokers (20 Active and 21 control) and 18 had biomass fuel exposure. 31of the 41 smokers reported that they had stopped smoking. Ax improved significantly in those who stopped smoking, compared to those who continued to smoke but no significant change was noted in R5 and R5–20. Conclusion Oscillometry helped diagnose pre-COPD and was able to objectively detect response to FF/V therapy as well as to smoking cessation. Pre-COPD can potentially be defined in at risk patients with normal spirometry if they have CAT>10 and Ax>10. A larger study is needed to assess whether these findings are reproducible and generalisable.

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