COPD: Combination Long-Acting Beta Agonists with Inhaled Steroids Leads To Fewer Hospitalizations

Andrea Gershon MD, MSc, FRCP(C) Scientist, Institute for Clinical Evaluative Sciences Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre Assistant Professor of Medicine, University of Toronto ICES Central Bayview Avenue, Toronto, OntarioMedicalResearch.com Interview with:
Andrea Gershon MD, MSc, FRCP(C)
Scientist, Institute for Clinical Evaluative Sciences
Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre
Assistant Professor of Medicine, University of Toronto
ICES Central Bayview Avenue, Toronto, Ontario

Medical Research: What are the main findings of the study?

Dr. Gershon: Within a large real world population of people with COPD, those who initiated combination long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS) were less likely to die or be hospitalized for COPD than those who initiated LABA alone. Further those who initiated LABA/ICS combination therapy did not appear to have more pneumonia or osteoporotic fractures – side effects that have been associated with ICS use—than those initiating LABA alone.

A second interesting finding was that people with a co-diagnosis of asthma experienced a greater incremental benefit of LABA/ICS over LABA than people without a co-diagnosis of asthma.

Finally, we found that people who were not also taking an inhaled long-acting anticholinergic medication experienced a greater incremental benefit of LABA/ICS over LABA than people who were.

Medical Research: Were any of the findings unexpected?

Dr. Gershon: The findings were interesting, but not unexpected.

Medical Research: What should clinicians and patients take away from your report?

Dr. Gershon: Our findings should be confirmed in prospective randomized clinical trials before being applied to patient care. However, until that is done, they offer important new knowledge that physicians can use to determine the best care for their patients. These findings might lead to a change in medication for certain patients depending on their circumstances.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Gershon: As mentioned above, our findings should be confirmed in prospective randomized clinical trials before being applied to patient care. Beyond that, this study examined two medication regiments in people with COPD in real world conditions. However, there are many other possible medication regiments and many different real world circumstances that people with COPD find themselves in. So, I believe that more studies of this nature are needed to determine how we can provide optimal care for people with COPD.

Citation:

Gershon AS, Campitelli MA, Croxford R, et al. Combination Long-Acting β-Agonists and Inhaled Corticosteroids Compared With Long-Acting β-Agonists Alone in Older Adults With Chronic Obstructive Pulmonary Disease. JAMA. 2014;312(11):1114-1121. doi:10.1001/jama.2014.11432.