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Long-acting beta2-agonists (LABA) are preferred add-on treatment for adult asthmatic patients whose symptoms cannot be controlled with inhaled corticosteroids (ICS) alone. However, over the last decade, long-acting muscarinic antagonists (LAMA) have gained approval for use in treating asthma, and their efficacy is anticipated. Therefore, we conducted a systematic review to investigate whether the addition of LABA or LAMA is more beneficial for the long-term management of adult asthmatic patients poorly controlled on ICS monotherapy. We extracted eight relevant randomized controlled trials (represented in 18 articles) conducted by June 2022 form the corresponding Cochrane review and additional searches through medical databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and ICHUSHI (https://www.jamas.or.jp/)). While the LAMA add-on group showed a significantly better improvement in some respiratory function tests, the difference between groups did not exceed the minimum clinically important difference (MCID). On the other hand, the Asthma Quality of Life Questionnaire, a quality of life metric, was significantly higher in the LABA add-on group, but the difference also did not surpass the MCID. Because no outcomes exceeded the MCID, we could not determine whether adding LABA or LAMA on ICS is more beneficial in the long-term management of adult asthmatic patients. Given that no significant differences were found in the incidence of adverse events (including serious ones), when specific adverse events associated with one treatment occur, switching to the other treatment (from LABA to LAMA, or vice versa) can be considered as an option.

Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory disorder and age-related disorder associated with increased prevalence of comorbid diseases such as cardiovascular diseases, and pulmonary complications such as lung cancer. We described here the clinical significance of comorbid diseases with COPD and briefly review the mechanism in the production of comorbid diseases.

A 58-year-old woman presented with cough and dyspnea on exertion. A chest CT scan showed infiltrative cuneiform shadows in the peripheral lung fields. Pulmonary perfusion scintigraphy showed multiple nonsegmental defects. Histological analysis of the transbronchial lung biopsy specimens obtained from the right lower lobe showed tumor cell embolism and fibrocellular intimal proliferation, but no thrombus formation or recanalization in the small arteries. On the basis of these findings, we diagnosed pulmonary tumor embolism, not pulmonary tumor thrombotic microangiopathy (PTTM), because the pathological findings did not reveal either thrombus formation or recanalization, and the patient did not show hemodynamic effects such as hemolytic anemia, severe pulmonary hypertension, or disseminated intravascular coagulation. Systemic examinations revealed uterine cervical cancer. Her symptoms improved after the administration of chemotherapy and radiation therapy. Furthermore, the multiple nonsegmental defects observed on pulmonary perfusion scintigraphy disappeared. She was discharged, and her uterine cervical cancer has not recurred to date. Generally, a diagnosis of pulmonary tumor embolism and PTTM is difficult to establish in living patients. It is important that therapy is started before the disease progresses to PTTM, if pulmonary tumor embolism is diagnosed.