Inhaled corticosteroids versus long-acting beta2-agonists for chronic obstructive pulmonary disease
Editorial Group: Cochrane Airways Group
Published Online: 7 DEC 2011
Assessed as up-to-date: 3 AUG 2011
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Spencer S, Karner C, Cates CJ, Evans DJ. Inhaled corticosteroids versus long-acting beta2-agonists for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD007033. DOI: 10.1002/14651858.CD007033.pub3.
- Publication Status: Edited (no change to conclusions)
- Published Online: 7 DEC 2011
To determine the relative effects of inhaled corticosteroids (ICS) compared to long-acting beta
We searched the Cochrane Airways Group Specialised Register of trials (latest search August 2011) and reference lists of articles.
We included randomised controlled trials comparing inhaled corticosteroids and long-acting beta
Data collection and analysis
Three authors independently assessed trials for inclusion and then extracted data on trial quality, study outcomes and adverse events. We also contacted study authors for additional information.
We identified seven randomised trials (5997 participants) of good quality with a duration of six months to three years. All of the trials compared ICS/LABA combination inhalers with LABA and ICS as individual components. Four of these trials included fluticasone and salmeterol monocomponents and the remaining three included budesonide and formoterol monocomponents. There was no statistically significant difference in our primary outcome, the number of patients experiencing exacerbations (odds ratio (OR) 1.22; 95% CI 0.89 to 1.67), or the rate of exacerbations per patient year (rate ratio (RR) 0.96; 95% CI 0.89 to 1.02) between inhaled corticosteroids and long-acting beta
Placebo-controlled trials have established the benefits of both long-acting beta-agonist and inhaled corticosteroid therapy for COPD patients as individual therapies. This review, which included trials allowing comparisons between LABA and ICS, has shown that the two therapies confer similar benefits across the majority of outcomes, including the frequency of exacerbations and mortality. Use of long-acting beta-agonists appears to confer a small additional benefit in terms of improvements in lung function compared to inhaled corticosteroids. On the other hand, inhaled corticosteroid therapy shows a small advantage over long-acting beta-agonist therapy in terms of health-related quality of life, but inhaled corticosteroids also increase the risk of pneumonia. This review supports current guidelines advocating long-acting beta-agonists as frontline therapy for COPD, with regular inhaled corticosteroid therapy as an adjunct in patients experiencing frequent exacerbations.
Plain language summary
Comparing inhaled corticosteroids with long-acting beta
2-agonists in treating chronic obstructive pulmonary disease (COPD)
Inhalers containing corticosteroids, long-acting beta
We looked at clinical trials that compared the two kinds of inhalers to find the effects of each on health and well-being in patients with COPD. We found seven studies (involving 5997 participants) comparing the long-term benefits and side effects of inhaled corticosteroids and long-acting beta