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      Inhaled therapy reduces COPD mortality

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      Author(s): 1 , 2 , 3 , 4
      Publication date (Electronic):
      Journal: ERJ Open Research
      Publisher: European Respiratory Society

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          Abstract

          The Global Initiative for Chronic Obstructive Lung Disease noted a lack of convincing evidence for a survival benefit with inhaled therapy in COPD despite relevant improvements in lung function, exacerbations and patient reported outcomes. Interestingly, recent studies investigating the role of triple therapy with long-acting β 2-agonist (LABA), long-acting muscarinic antagonist (LAMA) and inhaled glucocorticoid (ICS) showed that triple therapy could influence morbidity in patients with moderate to severe COPD.

          Abstract

          Plotting exacerbation rate versus mortality rate for the treatment groups in two recent controlled trials investigating triple therapy in COPD, there is a significant positive correlation supporting a positive impact of inhaled therapy on mortality https://bit.ly/35jbEiN

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          Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD

          David A. Lipson, Frank Barnhart, Noushin Brealey … (2018)
          The benefits of triple therapy for chronic obstructive pulmonary disease (COPD) with an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β2-agonist (LABA), as compared with dual therapy (either inhaled glucocorticoid-LABA or LAMA-LABA), are uncertain.
          Article 0 comments Cited 311 times – based on 0 reviews     Review now
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            Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease.

            Peter M.A. Calverley, Julie Anderson, Bartolome R Celli … (2007)
            Long-acting beta-agonists and inhaled corticosteroids are used to treat chronic obstructive pulmonary disease (COPD), but their effect on survival is unknown. We conducted a randomized, double-blind trial comparing salmeterol at a dose of 50 microg plus fluticasone propionate at a dose of 500 microg twice daily (combination regimen), administered with a single inhaler, with placebo, salmeterol alone, or fluticasone propionate alone for a period of 3 years. The primary outcome was death from any cause for the comparison between the combination regimen and placebo; the frequency of exacerbations, health status, and spirometric values were also assessed. Of 6112 patients in the efficacy population, 875 died within 3 years after the start of the study treatment. All-cause mortality rates were 12.6% in the combination-therapy group, 15.2% in the placebo group, 13.5% in the salmeterol group, and 16.0% in the fluticasone group. The hazard ratio for death in the combination-therapy group, as compared with the placebo group, was 0.825 (95% confidence interval [CI], 0.681 to 1.002; P=0.052, adjusted for the interim analyses), corresponding to a difference of 2.6 percentage points or a reduction in the risk of death of 17.5%. The mortality rate for salmeterol alone or fluticasone propionate alone did not differ significantly from that for placebo. As compared with placebo, the combination regimen reduced the annual rate of exacerbations from 1.13 to 0.85 and improved health status and spirometric values (P<0.001 for all comparisons with placebo). There was no difference in the incidence of ocular or bone side effects. The probability of having pneumonia reported as an adverse event was higher among patients receiving medications containing fluticasone propionate (19.6% in the combination-therapy group and 18.3% in the fluticasone group) than in the placebo group (12.3%, P<0.001 for comparisons between these treatments and placebo). The reduction in death from all causes among patients with COPD in the combination-therapy group did not reach the predetermined level of statistical significance. There were significant benefits in all other outcomes among these patients. (ClinicalTrials.gov number, NCT00268216 [ClinicalTrials.gov].). Copyright 2007 Massachusetts Medical Society.
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              Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD

              Klaus F Rabe, Fernando J Martínez, Gary Ferguson … (2020)
              Article 0 comments Cited 198 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): ERJ Open Res
                Journal ID (iso-abbrev): ERJ Open Res
                Journal ID (publisher-id): ERJOR
                Journal ID (hwp): erjor
                Title: ERJ Open Research
                Publisher: European Respiratory Society
                ISSN (Electronic): 2312-0541
                Publication date Collection: October 2020
                Publication date (Electronic): 30 November 2020
                Volume: 6
                Issue: 4
                Electronic Location Identifier: 00634-2020
                Affiliations
                [1 ]University Medical Center Göttingen, Göttingen, Germany
                [2 ]LungClinic Immenhausen, Immenhausen, Germany
                [3 ]Member of the German Center for Lung Research (DZL)
                [4 ]Dept of Pulmonary Medicine, University Hospital Essen – Ruhrlandklinik, Essen, Germany
                Author notes
                Stefan Andreas, LungClinic Immenhausen, R. Koch Str. 3, Immenhausen 34376, Germany. E-mail: Stefan.andreas@ 123456med.uni-goettingen.de
                Author information
                https://orcid.org/0000-0003-3918-6909
                Article
                Publisher ID: 00634-2020
                DOI: 10.1183/23120541.00634-2020
                PMC ID: 7701338
                SO-VID: 82fe653a-6b50-4845-b22a-c9556b493362
                Copyright © Copyright ©ERS 2020
                License:

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                Date received : 1 September 2020
                Date accepted : 4 September 2020
                Categories
                Subject: Correspondence
                Subject: 1

                Data availability:

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