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Aclidinium bromide is a long-acting muscarinic antagonist approved as a maintenance bronchodilator to relieve symptoms in adults with COPD. While randomized controlled trials have established the efficacy of aclidinium, real-world data are essential for understanding its effectiveness in routine clinical practice.<\/jats:p>\n                    <jats:p>This pooled analysis of data from two prospective observational studies conducted in Austria and Greece aimed to supplement real-world evidence on the effects of aclidinium bromide on QoL, symptoms, and activity impairment of patients with COPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eligible participants were \u226540 years old and newly initiated on aclidinium bromide as monotherapy or add-on therapy, according to the approved product\u2019s label. Patient-reported COPD assessment test (CAT), severity of night-time and early-morning symptoms, and interference of COPD with patients\u2019 daily activities were assessed at enrollment and the 12-week follow-up visit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One thousand one hundred twenty-seven patients (median age: 65.0 years, 65.8% male; 29.7% newly diagnosed) were enrolled between May 31st, 2013 and January 29th, 2016. Aclidinium bromide was initiated as monotherapy in 40.2% of patients. The median (interquartile range [IQR]) baseline CAT score decreased from 17.0 (11.0\u201323.0) to 11.0 (7.0\u201317.0) points (\n                      <jats:italic>p\u2009&lt;<\/jats:italic>\n                      \u20090.001) after 12 weeks of treatment, with 82.7% of patients achieving a \u2018minimal clinically important difference\u2019 (MCID, i.e., \u2265\u20092-point decrease). The severity of night-time and early-morning symptoms significantly decreased over the 12-week follow-up period (\n                      <jats:italic>p\u2009&lt;<\/jats:italic>\n                      \u20090.001 for both), while 51.9% of patients with \u2018at least moderate impact\u2019 of COPD on their daily activities at enrollment shifted to \u2018small or no impact\u2019 at the follow-up visit. Treatment with aclidinium was more likely to provide a clinically meaningful improvement in patients\u2019 symptoms in patients who were treatment-na\u00efve [adjusted odds ratio (OR): 2.14, 95% confidence interval (CI): 1.42\u20133.22;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001] and in those who were more symptomatic at baseline (OR: 1.13, 95% CI: 1.10\u20131.16;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This analysis of real-world data describes detailed aclidinium treatment benefit on COPD patients\u2019 QoL, symptom severity and daily activity impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The Austrian ON-AIR trial was registered in a national Austrian NIS register with trial registration number NIS004104. The Greek ONAIR trial was registered on the SFEE\u2019s (Hellenic Association of Pharmaceutical Companies) \u201cdilon\u201d registry, with trial registration number MeGR\/14\/BreCOPD\/001.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12890-026-04183-5","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T06:04:43Z","timestamp":1772258683000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of aclidinium bromide therapy on quality of life and symptoms of patients with chronic obstructive pulmonary disease: pooled analysis results of the Greek and Austrian ON-AIR real-world observational studies"],"prefix":"10.1186","volume":"26","author":[{"given":"Horst","family":"Olschewski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Tzanakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Brecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Wallner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Kassianou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiota","family":"Styliara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Landini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalia","family":"Mostafa Kamal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Mazzicone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Kostikas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"4183_CR1","unstructured":"The top 10 causes of death. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death. 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Respir Res. 2019;20:238.","journal-title":"Respir Res"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-026-04183-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-026-04183-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-026-04183-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:04:35Z","timestamp":1781636675000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12890-026-04183-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,28]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4183"],"URL":"https:\/\/doi.org\/10.1186\/s12890-026-04183-5","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,28]]},"assertion":[{"value":"28 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The national competent ethics committees approved the study protocols (Austrian Ethics Committee registration number 26\u2013210 ex 13\/14), and the study was conducted following the International Society for Pharmacoepidemiology guidelines for Good Pharmacoepidemiology Practice, the ethical principles of the Declaration of Helsinki, and all standing regulations of each participating country. Signed informed consent was obtained from all patients.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"E.W. and S.B. are employees of the Medical Department of A. Menarini Pharma GmbH. P.S. and I.K. are employees of the Medical Department of Menarini Hellas SA. K.K. has received honoraria for presentations and\/or consultancy fees from AstraZeneca, Boehringer Ingelheim, Chiesi, ELPEN, GSK, Guidotti, Menarini, Pfizer, Sanofi, Specialty Therapeutics. His department has received funding and\/or grants from AstraZeneca, Boehringer Ingelheim, Chiesi, ELPEN, GSK, Menarini. He was employed by AstraZeneca as Global Medical Head Respiratory Biologics. He is a member of the GOLD Assembly. H.O. has received honoraria for presentation and\/or consultancy fees from Aerovate, AOP, Astra Zeneca, Bayer, Boehringer Ingelheim, Chiesi, Ferrer, Janssen, Liquidia, Menarini, MSD, and Sanofi. L.L., D.M.K. and F.M. are employees of the Medical Department of A. Menarini Farmaceutica internazionale srl. The authors report no other conflicts of interest in this publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"157"}}