Work

Reply to Li et al.

Year: 2023

Type: letter

Abstract: However, to prove the effectiveness of reducing acute exacerbation in patients with COPD and T2D with GLP-1RAs is a daunting and challenging task, and there are several problems with Foer and colleagues' retrospective study.First of all, after stratification by body mass index (BMI), only the obese group showed a significant effect of GLP-1RAs in reducing acute exacerbations of COPD (4).Therefore, whether the effectiveness of reducing acute exacerbation in patients with COPD and T2D with GLP-1RAs is applicable to all populations needs to be further explored.Second, the study did not take into account the effect of the degree of change in BMI on the outcomes in an obese population.GLP-1RAs and sulfonylureas have different effects on body weight: GLP-1RAs have a weight-loss effect, whereas sulfonylureas have the opposite effect (5).Acute exacerbations of severe COPD are more likely in patients with COPD who are obese to a greater extent (6).By losing weight, obese patients with COPD have a reduced risk of hospitalization for acute exacerbations of COPD (7).We doubt that statistically significant differences in outcomes are attributable to weight changes due to drug effects of GLP-1RAs and sulfonylureas.More important, the prevalence of obstructive sleep apnea (OSA) was not included as a covariance.Obesity will lead to OSA, and OSA-COPD overlap syndrome is linked to an increased risk of death and hospitalization due to COPD exacerbation (8).GLP-1RAs may alleviate OSA by inducing weight loss, thereby reducing the rate of acute exacerbations of COPD.In conclusion, despite some remaining limitations, it is undeniable that Foer and colleagues' study (4) provides informative value for the selection of treatment regimens for patients with COPD and T2D and obesity.In the future, it is necessary to conduct a multicenter, randomized, double-blind, placebo-controlled trial of GLP-1RAs in patients with COPD and comorbid T2D.The design of the trial could be more rigorous.First, we suggest that confounding factors, such as the change in BMI between groups and the impact of COPD overlap syndrome related to obesity, be strictly controlled.In addition, more patients should be selected, including those with a phenotype of frequent exacerbations of COPD and healthy weight.Meanwhile, it is advisable to conduct follow-up for more than one year.Finally, we expect that this trial will provide stronger evidence for clinical treatment.

Source: American Journal of Respiratory and Critical Care Medicine

DOI: 10.1164/rccm.202310-1721le