This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine. Chronic obstructive pulmonary disease exacerbations and pneumonia hospitalizations among new users of combination maintenance inhalers. Mueller, MD, MPH, FACP, Regional Vice President – Southwest Wisconsin, Mayo Clinic Health System, La Crosse Professor of Medicine and Biomedical Ethics, Mayo Clinic College of Medicine and Science, Rochester, USA.įeldman WB, et al. Additionally, LAMA- LABA and ICS-LABA were not compared with triple therapy (ICS-LAMA-LABA), which is an option for patients with inadequate response to dual-therapy and who have eosinophilia ( NEJM JW Gen Med and Chest 2020 157: 846-855). Limitations include the possibility of residual confounding and that analyses were based on prescription fills, not actual use. Findings In this systematic review and meta-analysis that included 20 randomized clinical trials and 11 894 patients, triple therapy (ICS, LABA, and LAMA), compared with dual therapy (ICS plus LABA), was significantly associated with fewer severe asthma exacerbations (risk ratio, 0. Subgroup and sensitivity analyses yielded similar results.Ĭomment: This observational study adds support for combined LAMA-LABA inhalers over ICS-LABA inhalers in patients with COPD. requiring oral corticosteroid treatment for five to 14 days or hospitalisation, respectively) and significantly fewer first pneumonia hospitalisations (by 20%). Patients were followed for one year.Ĭompared with ICS-LABA treatment, LAMA-LABA treatment was associated with significantly fewer (by 8%) first moderate or severe COPD exacerbations (i.e. Using a large insurance claims database, researchers conducted this study of 31,000 propensity score–matched patient pairs (mean age, 70 years) with COPD who filled new prescriptions for LAMA-LABA or ICS-LABA inhalers from 2014 through 2019. The Global Initiative for Chronic Obstructive Lung Disease 2022 report recommends initial pharmacological treatment. ![]() ![]() However, the same trials have reported mixed results regarding pneumonia. Inhaled bronchodilators (alone or in combination) are the cornerstone of treatment for symptomatic patients with COPD, either as initial/first-line treatment or for second-line/treatment escalation in patients who experience persistent symptoms or exacerbations on monotherapy. Indeed, trials have shown that combined LAMA-LABA treatment prevents COPD exacerbations more effectively than does ICS-LABA treatment. LAMA-LABA was associated with fewer chronic obstructive pulmonary disease exacerbations and pneumonia hospitalisations than was corticosteroid plus LABA.Ĭurrent guidelines recommend inhalers containing a long-acting antimuscarinic antagonist (LAMA) plus a long-acting beta-agonist (LABA) over inhalers containing an inhaled corticosteroid (ICS) plus a LABA for patients with chronic obstructive pulmonary disease (COPD NEJM JW Gen Med and Am J Respir Crit Care Med 2023 207: 819-837).
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