Combination inhaled steroid and long-acting beta2-agonist in addition to tiotropium versus tiotropium or combination alone for chronic obstructive pulmonary disease
Editorial Group: Cochrane Airways Group
Published Online: 16 MAR 2011
Assessed as up-to-date: 2 AUG 2010
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Karner C, Cates CJ. Combination inhaled steroid and long-acting beta2-agonist in addition to tiotropium versus tiotropium or combination alone for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD008532. DOI: 10.1002/14651858.CD008532.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 16 MAR 2011
The long-acting bronchodilator tiotropium and single inhaler combination therapy of inhaled corticosteroids and long-acting beta
To assess the relative effects of inhaled corticosteroid and long-acting beta
We searched the Cochrane Airways Group Specialised Register of trials (July 2010) and reference lists of articles.
We included parallel, randomised controlled trials of three months or longer, comparing inhaled corticosteroid and long-acting beta
Data collection and analysis
We independently assessed trials for inclusion and then extracted data on trial quality and outcome results. We contacted study authors for additional information. We collected information on adverse effects from the trials.
Three trials (1021 patients) were included comparing tiotropium in addition to inhaled corticosteroid and long-acting beta
One trial (60 patients) compared tiotropium plus combination therapy to combination therapy alone. The results from the trial were insufficient to draw firm conclusions for this comparison.
To date there is uncertainty regarding the long-term benefits and risks of treatment with tiotropium in addition to inhaled corticosteroid and long-acting beta
Plain language summary
Are tiotropium plus combination inhalers better than tiotropium or combination inhalers alone for the treatment of COPD?
Chronic obstructive pulmonary disease (COPD) is a lung disease which includes the conditions chronic bronchitis and/or emphysema. COPD is characterised by blockage or narrowing of the airways. The symptoms include breathlessness and chronic cough. COPD is an irreversible disease that is usually brought on by airway irritants, such as smoking or inhaled dust.
Inhalers with bronchodilators and/or anti-inflammatory agents are commonly used to ease symptoms and minimise the long-term decline in health caused by COPD. Examples of these treatments are tiotropium which is a bronchodilator and combination inhalers which contain another type of bronchodilator (long-acting beta-agonists) together with anti-inflammatory agents (steroids). These treatments work in different ways and therefore might be more beneficial if used together.
This review found three studies, involving 1021 patients, comparing the long-term efficacy and side effects of combining tiotropium with combination inhalers for treating COPD. In these studies there were not enough patients and the studies were too different from each other for us to be able to draw any firm conclusions as to whether combining tiotropium with combination inhalers is better or worse than using either drug alone for mortality, hospitalisation and pneumonia. The addition of combination inhalers to tiotropium did show small benefits in quality of life and lung function tests.
In order to better understand the effect of treatment with tiotropium and combination inhaler more long-term studies need to be done.