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Combined corticosteroid and long-acting beta2-agonist in one inhaler versus inhaled corticosteroids alone for chronic obstructive pulmonary disease

  1. Luis Javier Nannini1,*,
  2. Phillippa Poole2,
  3. Stephen J Milan3,
  4. Annabel Kesterton4

Editorial Group: Cochrane Airways Group

Published Online: 30 AUG 2013

Assessed as up-to-date: 27 JUN 2013

DOI: 10.1002/14651858.CD006826.pub2


How to Cite

Nannini LJ, Poole P, Milan SJ, Kesterton A. Combined corticosteroid and long-acting beta2-agonist in one inhaler versus inhaled corticosteroids alone for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006826. DOI: 10.1002/14651858.CD006826.pub2.

Author Information

  1. 1

    Hospital E Peron, Pulmonary Section, G. Baigorria, Santa Fe - Rosario, Argentina

  2. 2

    University of Auckland, Department of Medicine, Auckland, New Zealand

  3. 3

    St George's, University of London, Population Health Sciences and Education, London, UK

  4. 4

    St George's University of London, Population Health Sciences and Education, London, UK

*Luis Javier Nannini, Pulmonary Section, Hospital E Peron, Ruta 11 Y Jm Estrada, G. Baigorria, Santa Fe - Rosario, 2152, Argentina. nanninilj@circulomedicorosario.org.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 30 AUG 2013

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[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
[Figure 3]
Figure 3. Forest plot of comparison: 1 All Combined Inhalers-Primary Outcomes, outcome: 1.1 Exacerbation rates (exacerbations requiring oral corticosteroids).
[Figure 4]
Figure 4. Forest plot of comparison: 1 All Combined Inhalers-Primary Outcomes, outcome: 1.2 Number of participants with one or more exacerbation.
[Figure 5]
Figure 5. Forest plot of comparison: 1 All Combined Inhalers-Primary Outcomes, outcome: 1.3 Hospitalisations due to COPD exacerbations.
[Figure 6]
Figure 6. Forest plot of comparison: 1 All Combined Inhalers-Primary Outcomes, outcome: 1.4 Mortality.
[Figure 7]
Figure 7. Forest plot of comparison: 1 All Combined Inhalers-Primary Outcomes, outcome: 1.5 Pneumonia.
[Figure 8]
Figure 8. Funnel plot of comparison: 1 All Combined Inhalers-Primary Outcomes, outcome: 1.4 Mortality.
[Analysis 1.1]
Analysis 1.1. Comparison 1 All Combined Inhalers - Primary Outcomes, Outcome 1 Exacerbation rates (exacerbations requiring oral corticosteroids).
[Analysis 1.2]
Analysis 1.2. Comparison 1 All Combined Inhalers - Primary Outcomes, Outcome 2 Number of participants with one or more exacerbation.
[Analysis 1.3]
Analysis 1.3. Comparison 1 All Combined Inhalers - Primary Outcomes, Outcome 3 Hospitalisations due to COPD exacerbations.
[Analysis 1.4]
Analysis 1.4. Comparison 1 All Combined Inhalers - Primary Outcomes, Outcome 4 Mortality.
[Analysis 1.5]
Analysis 1.5. Comparison 1 All Combined Inhalers - Primary Outcomes, Outcome 5 Pneumonia.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 1 Exacerbation rates.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 2 Number of participants with one or more exacerbation.
[Analysis 2.3]
Analysis 2.3. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 3 End of treatment mean number of exacerbations per participant.
[Analysis 2.4]
Analysis 2.4. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 4 Number of participants with one or more exacerbations by type.
[Analysis 2.5]
Analysis 2.5. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 5 Exacerbations by type.
[Analysis 2.6]
Analysis 2.6. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 6 Mortality.
[Analysis 2.7]
Analysis 2.7. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 7 Mortality-cause specific.
[Analysis 2.8]
Analysis 2.8. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 8 Change from baseline in St George's Respiratory Questionnaire (total score).
[Analysis 2.9]
Analysis 2.9. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 9 Change from baseline in Transitional Dyspnoea Index (TDI).
[Analysis 2.10]
Analysis 2.10. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 10 Change from baseline in Chronic Respiratory Disease Questionnaire scores.
[Analysis 2.11]
Analysis 2.11. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 11 Change from baseline in predose FEV1.
[Analysis 2.12]
Analysis 2.12. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 12 Change from baseline in post-dose FEV1.
[Analysis 2.13]
Analysis 2.13. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 13 End of treatment am PEF (L/min).
[Analysis 2.14]
Analysis 2.14. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 14 Absolute shuttle walk test.
[Analysis 2.15]
Analysis 2.15. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 15 Change from baseline in rescue medication usage (puffs/d).
[Analysis 2.16]
Analysis 2.16. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 16 Withdrawals.
[Analysis 2.17]
Analysis 2.17. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 17 Withdrawal due to lack of efficacy/exacerbation.
[Analysis 2.18]
Analysis 2.18. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 18 Withdrawals due to adverse events.
[Analysis 2.19]
Analysis 2.19. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 19 Adverse events-any event.
[Analysis 2.20]
Analysis 2.20. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 20 Adverse events-serious.
[Analysis 2.21]
Analysis 2.21. Comparison 2 Fluticasone/salmeterol (FPS) versus fluticasone (FP), Outcome 21 Adverse events (specific adverse events).
[Analysis 3.1]
Analysis 3.1. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 1 Exacerbations.
[Analysis 3.2]
Analysis 3.2. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 2 Mean exacerbation rates per participant per year.
[Analysis 3.3]
Analysis 3.3. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 3 Mortality.
[Analysis 3.4]
Analysis 3.4. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 4 Quality of life-SGRQ total (change scores).
[Analysis 3.5]
Analysis 3.5. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 5 Symptoms (change scores).
[Analysis 3.6]
Analysis 3.6. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 6 Breathlessness, cough and sputum score (BCSS) change from baseline-average over treatment period.
[Analysis 3.7]
Analysis 3.7. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 7 Awakening-free nights, percentage change from baseline.
[Analysis 3.8]
Analysis 3.8. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 8 Mean FEV1 (% increase from baseline).
[Analysis 3.9]
Analysis 3.9. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 9 Pre-dose FEV1 [L] change from baseline to the average over the randomised treatment period.
[Analysis 3.10]
Analysis 3.10. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 10 1-Hour post-dose FEV1 [L] change from baseline to the average over the randomised treatment period.
[Analysis 3.11]
Analysis 3.11. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 11 Morning PEFR change from baseline, average over treatment period (L/min).
[Analysis 3.12]
Analysis 3.12. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 12 Evening PEFR mean change from baseline, average over treatment period (L/min).
[Analysis 3.13]
Analysis 3.13. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 13 Rescue medication use.
[Analysis 3.14]
Analysis 3.14. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 14 Sleep score (0 to 4)-change from baseline.
[Analysis 3.15]
Analysis 3.15. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 15 Dyspnoea score (0 to 4)-change from baseline.
[Analysis 3.16]
Analysis 3.16. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 16 Cough score (0 to 4)-change from baseline.
[Analysis 3.17]
Analysis 3.17. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 17 Sputum score (0 to 4)-change from baseline.
[Analysis 3.18]
Analysis 3.18. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 18 Withdrawals due to worsening COPD symptoms.
[Analysis 3.19]
Analysis 3.19. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 19 Withdrawals due to adverse events.
[Analysis 3.20]
Analysis 3.20. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 20 Adverse event-any (one or more).
[Analysis 3.21]
Analysis 3.21. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 21 Adverse events-serious events.
[Analysis 3.22]
Analysis 3.22. Comparison 3 Budesonide/formoterol (BDF) versus budesonide (BD), Outcome 22 Adverse events (specific adverse events).
[Analysis 4.1]
Analysis 4.1. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 1 Patients with one or more exacerbation.
[Analysis 4.2]
Analysis 4.2. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 2 Mortality.
[Analysis 4.3]
Analysis 4.3. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 3 Change from baseline in SGRQ (total score).
[Analysis 4.4]
Analysis 4.4. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 4 Change from baseline in FEV1 AUC0-12 h (mL) week 26.
[Analysis 4.5]
Analysis 4.5. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 5 Change from baseline in FEV1 AUC0-12 h (mL) week 13.
[Analysis 4.6]
Analysis 4.6. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 6 Mean change from baseline AM pre-dose FEV1 at 13 weeks (mL).
[Analysis 4.7]
Analysis 4.7. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 7 Withdrawals-total.
[Analysis 4.8]
Analysis 4.8. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 8 Withdrawals due to adverse event.
[Analysis 4.9]
Analysis 4.9. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 9 Withdrawal due to treatment failure.
[Analysis 4.10]
Analysis 4.10. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 10 Adverse event-any.
[Analysis 4.11]
Analysis 4.11. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 11 Adverse event-serious.
[Analysis 4.12]
Analysis 4.12. Comparison 4 Mometasone/formoterol (MF/F) versus Mometasone (MF), Outcome 12 Adverse events (specific adverse events).