LAMA/LABA better and safer than ICS/LABA for COPD

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Goodfellow Gems

"LAMA/LABA better and safer than ICS/LABA for COPD"

A trial with COPD patients with a history of at least one exacerbation in the past year found a LABA indacaterol (110 μg) plus the LAMA glycopyrronium (50 μg) once daily versus the LABA salmeterol (50 μg) plus the inhaled glucocorticoid fluticasone (ICS) (500 μg) twice daily was associated with an 11% reduction in exacerbations (3.59 vs. 4.03 p = 0.003).1 Adverse events and deaths were similar. 

Prof John Kolbe comments “the advice that LAMA (+/- LABA) is the preferred treatment for most COPD patients2 is supported by this study, despite the fact that the study population was that which other guidelines recommend be treated with inhaled corticosteroids (ICS). There is likely to be a group who respond to ICS (? a long Hx of asthma) but responses were independent of the baseline blood eosinophil count.  Studies are underway to identify such a sub-group.

This is further evidence of the increased rate of pneumonia in COPD patients using ICS 3.2% vs 4.8%."

This Gem has been checked by Professor John Kolbe a respiratory physician at Auckland City Hospital.

References:

  1. Indacaterol–Glycopyrronium versusSalmeterol–Fluticasone for COPD. Click here
  2. BPAC. The optimal management of patients with COPD - Part 2: Stepwise escalation of treatment. Click here

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.


As published in NZ Doctor 17/08/2016