Efficacy and safety of inhaled pharmacotherapy in patients with pneumoconiosis and airway obstruction: a retrospective cohort study from China

OBJECTIVE: Pneumoconiosis often coexists with airway obstruction, yet evidence on inhaled pharmacotherapy in this population is limited. METHODS: We retrospectively studied patients with pneumoconiosis and post-bronchodilator FEV₁/FVC <70% (2018-2022). Eligible patients (≥40 years) were grouped by regular (≥12 months) or irregular/no inhaled therapy. Outcomes included FEV₁, symptoms, exacerbations, hospitalizations, and adverse events. Symptom burden was assessed using the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) dyspnea scale. Propensity score matching and logistic regression identified predictors of response. RESULTS: After matching, 228 patients were analyzed. Regular therapy yielded greater FEV₁ improvement (88 vs 15 mL, p<0.001), better CAT and mMRC responses, and fewer exacerbations and hospitalizations (p<0.05), with similar adverse events. Higher baseline FEV₁% predicted response. CONCLUSION: Regular inhaled pharmacotherapy improved lung function, symptoms, and exacerbation outcomes in pneumoconiosis with airway obstruction without added safety concerns.