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Miscellaneous

Combined corticosteroid and longacting beta-agonist in one inhaler for chronic obstructive pulmonary disease

  1. L Nannini Head*,
  2. TJ Lasserson,
  3. P Poole

Editorial Group: Cochrane Airways Group

Published Online: 21 JUL 2003

DOI: 10.1002/14651858.CD003794


How to Cite

Nannini L, Lasserson TJ, Poole P. Combined corticosteroid and longacting beta-agonist in one inhaler for chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003794. DOI: 10.1002/14651858.CD003794.

Author Information

  1. Hospital G. Baigorria, Pulmonary Section, G. Baigorria, Santa Fe - Rosario, ARGENTINA

*L Nannini, Head, Pulmonary Section, Hospital G. Baigorria, Ruta 11 Y Jm Estrada, G. Baigorria, Santa Fe - Rosario, 2152, ARGENTINA. nanninilj@cimero.org.ar.

Publication History

  1. Published Online: 21 JUL 2003

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Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

Long-acting beta-agonists and inhaled corticosteroids have been recommended in guidelines for the treatment of chronic obstructive pulmonary disease. However, they have only been available until recently via separate administration. They have been developed in order to facilitate adherence to medication regimens, and to improve efficacy.

Objectives

To assess the efficacy of combined inhaled corticosteroid and long-acting beta-agonist preparations in the treatment of adults with chronic obstructive pulmonary disease.

Search strategy

We searched the Cochrane Airways Group chronic obstructive pulmonary disease (COPD) trials register (March 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2003), LILACS (all years to March 2003) and reference lists of articles. We also contacted manufacturers and researchers in the field.

Selection criteria

Studies were included if they were randomised, with adequate blinding procedures in place. Studies could compare a combined inhaled corticosteroids and long-acting beta-agonist preparation with either component preparation or placebo. Studies comparing different members of each class of combined therapies were included

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data.

Main results

Four randomised trials with 2986 participants were included. Two different combination preparations (fluticasone/salmeterol and budesonide/formoterol) were studied in the trials. No meta-analysis on clinical outcomes was possible due to different outcome assessment across studies. All studies demonstrated a reduction in exacerbation rates versus placebo. Budesonide/formoterol was more effective than formoterol in reducing exacerbations in one study from 1.84 to 1.42 exacerbations per year. Fluticasone/salmeterol did not significantly reduce exacerbations compared with either of its component treatments. Fluticasone/salmeterol led to better quality of life compared with placebo (two studies), although there were conflicting results when compared with inhaled corticosteroid alone (two studies). There was no significant difference between fluticasone/salmeterol and long-acting beta-agonist (two studies). Budesonide/formoterol led to statistically significant differences in quality of life compared with placebo, but not when compared with component inhaled corticosteroid or beta-agonist (one study).

Reviewers' conclusions

For the primary outcome of exacerbations, budesonide/formoterol had a modest advantage over a component medication, formoterol, in a single trial, but fluticasone/salmeterol did not result in a significant reduction in exacerbations compared to either of its components. The combination of steroids and long-acting beta-agonist in one inhaler was effective in improving symptoms compared with placebo and on certain clinical outcomes compared with one of the individual components alone. In order to draw firmer conclusions about the effects of combination therapy in a single inhaler more data are necessary, including the assessment of the comparative effects with separate administration of the two drugs in double-dummy trials.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Synopsis

Limited evidence shows that combination therapy may improve some outcomes in people with chronic obstructive pulmonary disease, but more research is required.

Chronic obstructive pulmonary disease (COPD) is a disease which is characterised by severely obstructed airflow from the lungs. The main cause of COPD is smoking. Recently, combinations of two classes of medication in one inhaler have been developed as it is thought that this approach may provide a better effect than taking the two therapies separately or alone. Possible benefits include quality of life, reduction in exacerbations and improved lung function. In this review the combination of a inhaled corticosteroid (anti-inflammatory therapy) and long-acting beta agonist (bronchodilator therapy) was assessed. Very few studies were included. The combined medications in one inhaler was better than placebo (dummy medication) for all of the outcomes that were measured, however, at this time there seems to be only a small benefit of the combination over either one of the active component medicines in terms of reducing the frequency of flare ups of COPD.