The Indacaterol: Switching Non-exacerbating Patients with Moderate COPD From Salmeterol/Fluticasone to Indacaterol (INSTEAD) study investigated the effect of switching patients at low risk of chronic obstructive pulmonary disease (COPD) exacerbations from salmeterol/fluticasone (SFC; inhaled corticosteroid (ICS) regimen) to indacaterol monotherapy (non-ICS regimen).This 26-week, double-blind, double-dummy, parallel-group, phase IV study, randomised 581 patients with moderate COPD to indacaterol 150 mg once daily or SFC 50/500 mg twice daily. Patients had been receiving SFC 50/500 mg for o3 months, with no COPD exacerbations for more than a year before the study (patients for whom ICS is not recommended). The primary objective was to demonstrate noninferiority of indacaterol to SFC, measured by trough forced expiratory volume in 1 second (FEV1) after 12 weeks (non-inferiority margin of 0.06 L).The primary objective was met, with a mean treatment difference of 9 mL (95% CI -45-26 mL). There were no significant differences between treatments in terms of breathlessness (transition dyspnoea index) or health status (Saint George's Respiratory Questionnaire) at weeks 12 or 26, or rescue medication use or COPD exacerbation rates over 26 weeks. Safety profiles of both treatments were as expected.This study demonstrated that patients with moderate COPD and no exacerbations in the previous year can be switched from SFC to indacaterol 150 mg with no efficacy loss. @ERSpublications Moderate COPD patients can switch from salmeterol/fluticasone to indacaterol with no efficacy loss

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[1] In this work we demonstrate that the combination of agent-based modeling and simulation constitutes a useful methodological approach to dealing with the complexity derived from multiple factors with influence in the domestic water management in emergent metropolitan areas. In particular, we adapt and integrate different social submodels, models of urban dynamics, water consumption, and technological and opinion diffusion, in an agent-based model that is, in turn, linked with a geographic information system. The result is a computational environment that enables simulating and comparing various water demand scenarios. We have parameterized our general model for the metropolitan area of Valladolid (Spain).The model shows the influence of urban dynamics (e.g., intrapopulation movements, residence typology, and changes in the territorial model) and other socio-geographic effects (technological and opinion dynamics) in domestic water demand. The conclusions drawn in this way would have been difficult to obtain using other approaches, such as conventional forecasting methods, given the need to integrate different socioeconomic and geographic aspects in one single model. We illustrate that the described methodology can complement conventional approaches, providing descriptive and formal additional insights into domestic water demand management problems.

Background and objective Asthma and chronic obstructive pulmonary disease (COPD) are two prevalent and complex diseases that require personalized management. Although a strategy based on treatable traits (TTs) has been proposed, the prevalence and relationship of TTs to the diagnostic label and disease severity established by the attending physician in a real‐world setting are unknown. We assessed how the presence/absence of specific TTs relate to the diagnosis and severity of ‘asthma’, ‘COPD’ or ‘asthma + COPD’. Methods The authors selected 30 frequently occurring TTs from the NOVELTY study cohort (NOVEL observational longiTudinal studY; NCT02760329), a large (n = 11,226), global study that systematically collects data in a real‐world setting, both in primary care clinics and specialized centres, for patients with ‘asthma’ (n = 5932, 52.8%), ‘COPD’ (n = 3898, 34.7%) or both (‘asthma + COPD’; n = 1396, 12.4%). Results The results indicate that (1) the prevalence of the 30 TTs evaluated varied widely, with a mean ± SD of 4.6 ± 2.6, 5.4 ± 2.6 and 6.4 ± 2.8 TTs/patient in those with ‘asthma’, ‘COPD’ and ‘asthma + COPD’, respectively (p < 0.0001); (2) there were no large global geographical variations, but the prevalence of TTs was different in primary versus specialized clinics; (3) several TTs were specific to the diagnosis and severity of disease, but many were not; and (4) both the presence and absence of TTs formed a pattern that is recognized by clinicians to establish a diagnosis and grade its severity. Conclusion These results provide the largest and most granular characterization of TTs in patients with airway diseases in a real‐world setting to date.

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