For patients with moderate to severe chronic obstructive pulmonary disease (COPD), treatment options include a long-acting beta-agonist (LABA) alone or a LABA combined with an inhaled corticosteroid (ICS). In US practice, a LABA/ICS combination is more commonly used than LABA monotherapy, but does the ICS component contribute to long-term outcomes?
Previous studies have shown that use of a LABA/ICS combination provides short-term benefits, such as symptom relief and a reduction in acute exacerbations. However, these benefits can be obtained with a LABA alone, and the incremental benefit of adding an ICS is of questionable clinical significance. We also know that use of inhaled corticosteroids has adverse effects in the long term, particularly osteoporosis and pneumonia. No single study has been able to show a mortality benefit for an ICS alone or the addition of an ICS to a LABA.
A recent study addressed the possibility that previous trials exploring the mortality question were too small to provide a definitive answer, and that combining all of the available trial results might provide a clearer answer. The study was a meta-analysis that included all prospective, double-blind, randomized trials comparing the long-term outcomes of a LABA alone vs that of a LABA-ICS combination. Read the results of this study at Medscape Today – click here