The role of combination therapy with corticosteroids and long-acting β₂-agonists in the prevention of exacerbations in COPD

Abstract

Acute exacerbations of COPD can complicate the course of the disease in patients with severe airway obstruction. Reduction of exacerbations is an important clinical outcome in evaluating new therapies in COPD. Combination therapies with long-acting β-agonists and inhaled corticosteroids have now been approved for use. Three 1-year randomized clinical trials, which studied the effect of combining a long-acting β₂-agonist with an inhaled corticosteroid in COPD, documented that exacerbation frequency was lower with therapy than placebo. Combination therapy had a similar effect to its monocomponents in the trial evaluating salmeterol/fluticasone combination. However, when patients with more severe COPD were studied using a combination of budesonide and formoterol, a clear improvement was seen in the overall exacerbation rates compared with the use of a long-acting β₂-agonist alone.

Keywords:

• COPD
• exacerbation
• inhaled corticosteroids
• inhaled long-acting β₂-agonists
• budesonide
• fluticasone
• formoterol
• salmeterol
• combination therapy

Disclosures

Dr Cazzola has received financial support for research and attending meetings and fees for speaking and consulting from Abbott, Altana, AstraZeneca, Boerhinger Ingelheim, Chiesi Farmaceutici, GSK, Meda, Menarini Farmaceutici, Novartis, Pfizer, and Valeas. Dr Hanania has received research grant support from GSK, Boerhinger Ingelheim, AstraZeneca, Dey, Sepracor, and Altana and has served on the advisory board for GSK and Dey. No funding source had any role in the preparation of this paper.