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Background  Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting  2  agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients.    Methods  Between January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical record to evaluate that LAMA/LABA might be an optimal regimen for patients with COPD undergoing surgery for lung cancer. All patients were received perioperative rehabilitation and divided into 3 groups according to the type of perioperative inhaled therapy and management: LAMA/LABA (n=64), LAMA (n=23) and rehabilitation only (no bronchodilator) (n=43). We conducted a retrospective review of their medical records.    Results  Patients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery ( p <0.001 for both forced expiratory volume in 1s (FEV 1 ) and percentage of predicted forced expiratory volume in 1s (FEV 1 %pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (FEV 1 , LAMA/LABA 223.1mL vs. LAMA 130.0mL, FEV 1 %pred, LAMA/LABA 10.8% vs. LAMA 6.8%; both  p <0.05). Postoperative complications were lower frequent in the LAMA/LABA group than in the LAMA group ( p =0.007). In patients with moderate to severe air flow limitation (n=61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with the LAMA ( p =0.049,  p =0.026) and rehabilitation-only groups ( p =0.001,  p <0.001). Perioperative LAMA/LABA therapy was also associated with lower recurrence rates (vs. LAMA  p =0.006, vs. rehabilitation-only  p =0.008).    Conclusions  We believe this treatment combination is optimal for patients with lung cancer and COPD.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12890-021-01537-z.

Prognostic and functional impact of perioperative LAMA/LABA inhaled therapy in patients with lung cancer and chronic obstructive pulmonary disease