Combined corticosteroid and long-acting beta-agonist in one inhaler versus placebo for chronic obstructive pulmonary disease

Nannini, Luís J.; Cates, Christopher J; Lasserson, Toby J; Poole, Phillippa

doi:10.1002/14651858.cd003794.pub3

Cited by 70 publications

(82 citation statements)

References 68 publications

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“…In this study, both the inhaled steroid-containing arms were associated with increased incidence of pneumonia, with a doubling of the incidence in the combination arm from 4 to 8% over the 3-yr period. A meta-analysis of 11 studies of combination preparations (fluticasone/salmeterol and budesonide/formoterol) has confirmed these findings, with an OR 1.83 (95% CI 1.51-2.21) increase in the overall risk for pneumonia attributed to the combination treatment [34]. In a retrospective database analysis, the effect appeared to be dose-related, with doses .1,000 mcg?day -1 of beclomethasone equivalent more likely to be linked to pneumonia than lower doses.…”

Section: Community-acquired Pneumonia In Copdmentioning

confidence: 81%

Infection as a comorbidity of COPD

2010

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The normal lung has several defence mechanisms to deal with microorganisms. Lower respiratory infections in the absence of lung disease are therefore relatively infrequent as compared with upper respiratory tract infections in healthy adults. In the setting of chronic obstructive pulmonary disease (COPD), lower respiratory tract infections, both acute and chronic, occur with increased frequency. As these infections contribute considerably to the clinical course of the patient with COPD, they constitute a significant comorbidity in COPD. Recurrent acute infections by bacterial and/or viral pathogens are now clearly linked with the occurrence of exacerbations of COPD. In addition, the occurrence of pneumonia in COPD has received considerable recent attention as it appears to be increased by the use of inhaled corticosteroids. The role of chronic infection in the pathogenesis of COPD is an active area of research with several different types of pathogens potentially implicated. Additionally, COPD patients with HIV infection have a more rapidly progressive decline in lung function than non-HIV-infected patients. Enhanced understanding of the host-pathogen interaction is needed to better prevent and treat respiratory tract infection in COPD.

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Section: Community-acquired Pneumonia In Copdmentioning

confidence: 81%

Infection as a comorbidity of COPD

2010

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“…The 393 study observed a relative reduction in mortality of 17% over three years for patients receiving 394 SLM/FP, although this just failed to reach statistical significance. A subsequent Cochrane review 395 observed survival benefits with combination therapy compared both to placebo (34) and to ICS 396 alone (14). In vivo studies using bronchial biopsies have generated further supporting evidence 397 for complementary interactions between LABAs and corticosteroids on airway inflammation and 398 pathology in COPD patients (18,19).…”

Section: Usmani 18mentioning

confidence: 99%

Inhaled long-acting β2 agonists enhance glucocorticoid receptor nuclear translocation and efficacy in sputum macrophages in COPD

Haque

Hakim

Moodley

et al. 2013

Journal of Allergy and Clinical Immunology

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“…10 Any benefits come at the cost of an increased risk of pneumonia as well as oral candidiasis, voice hoarseness and skin bruising. 19,20 However, this patient only has a moderate obstructive defect so if significant dyspnoea persists in spite of the above suggestions, further assessment at a specialist respiratory clinic may be warranted. This would allow full lung function tests to be performed including gas transfer and lung volumes (that are not routinely available in primary care), and further assessment with CT scans which in specific clinical situations may lead to some of the newer treatments including lung volume reduction therapy.…”

Section: Pharmacological Managementmentioning

confidence: 97%

How I would manage a woman with COPD who is symptomatic but at low risk of an exacerbation: a primary care perspective from the UK

Dunn

2012

Primary Care Respiratory Journal

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This 61 year-old lady with an established history of COPD (dyspnoea in the context of a 20-40 pack year smoking history and obstructive spirometry that persists despite bronchodilation) has become more breathless over recent months. Further management will depend on a thorough assessment of the cause of her current breathlessness and the effect of her symptoms on everyday activities. What is causing her breathlessness?77% of people with COPD have at least one other long-term condition -most commonly cardiac in origin -that can cause breathlessness.1 They are also at higher risk of lung cancer 2 as a result of their smoking history. I would therefore ask about a history of increasing persistent cough, haemoptysis, ankle swelling, palpitations, chest pain and paroxysmal nocturnal dyspnoea. An electrocardiogram and chest X-ray will look for evidence of cardiac and other pulmonary disease, and a full blood count will exclude anaemia. Recent dramatic decline in pulmonary function can be assessed by up-to-date spirometry.If we accept that her problems are due to the COPD then her current burdensome symptoms need attention. Assessment of current symptomsI would want to understand what symptoms are really causing her trouble: what can she not do that she wants to do? A tool such as the COPD Assessment Tool (CAT) can look at specifics such as the effect of COPD on sleep, isolation and exercise; a score of 10 or more indicates a high impact of symptoms.3 She has retired recently and was looking forward to time in her garden and with her grandchildren. That does not seem to have happened as anticipated, maybe causing depression, which is 2-3 times commoner in people with long-term conditions than in those with good physical health. What is she hoping to achieve? An holistic assessment such as thiswith involvement of, and shared understanding with, the patientallows an individualised management plan to be formulated with a greater likelihood of success. 5As part of this assessment, future risk needs to be considered; this is most closely related to exacerbation frequency. The DOSE score is a validated primary care-friendly tool that can predict risk of exacerbation 6 (see Table 1). In this case her moderate reduction in FEV 1 , current (albeit recent) non-smoking status, and rare exacerbations, means that she is at low risk despite her high symptom-based modified MRC Dyspnoea score of 3. It would, however, be important to record future exacerbations to allow on-going risk assessment. Clinical scenarioA 61 year-old lady is concerned about her increasing breathlessness. When she retired last year from her job as a secretary she was looking forward to gardening, and joining in activities with her grandchildren. She has discovered that anything more than gentle exercise makes her breathless and she has to stop for rest. COPD was first diagnosed 10 years ago and spirometry last year recorded an FEV1/FVC ratio of 0.45 and a post-bronchodilator FEV1 of 55% predicted. After nearly 40 years of smoking between 10 and 20 cigarettes a...

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Combined corticosteroid and long-acting beta-agonist in one inhaler versus placebo for chronic obstructive pulmonary disease

Cited by 70 publications

References 68 publications

Infection as a comorbidity of COPD

Infection as a comorbidity of COPD

Inhaled long-acting β2 agonists enhance glucocorticoid receptor nuclear translocation and efficacy in sputum macrophages in COPD

How I would manage a woman with COPD who is symptomatic but at low risk of an exacerbation: a primary care perspective from the UK

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