LABA-LAMA preferred over LABA-ICS inhalers for preventing COPD exacerbations
Long-acting beta2-agonist (LABA) plus long-acting muscarinic antagonist (LAMA) combinations compare with inhalers containing both LABA and corticosteroid (LABA-ICS) in terms of reducing chronic obstructive pulmonary disease (COPD) exacerbations, although the LAMA-LABA combination is more favourable as it is associated with fewer episodes of severe pneumonia, according to a study.
Researchers used data from the United Kingdom’s Clinical Practice Research Datalink and identified 1,977 initiators of LABA-LAMA and 1,977 matched initiators of LABA-ICS.
All patients were aged ≥55 years and followed for 12 months for the occurrence of a moderate or severe COPD exacerbation and severe pneumonia.
There was no significant difference in the incidence of exacerbations between the two groups. In multivariable Cox analysis the respective hazard ratios (HRs) for moderate and severe COPD exacerbations associated with LABA-LAMA initiation vs LABA-ICS initiation were 1.04 (95 percent CI, 0.90–1.20) and 0.94 (0.65–1.36).
However, results for the incidence of severe pneumonia requiring hospitalization were better with LABA-LAMA (HR, 0.66; 0.41–1.05), particularly in the on-treatment analysis (HR, 0.66; 0.50–0.87).
Use of LABA-LAMA inhalers are crucial to symptom management in COPD, improving lung function and health-related quality of life. Additionally, they prevent exacerbations and increase exercise endurance by reducing pulmonary hyperinflation and dyspnoea. [Eur Respir J 2012;40:1545-1554]
On the other hand, LABA-ICS combinations are indicated for patients with severe-to-very-severe disease and a history of repeated exacerbations. In spite of these indications, LABA/ICS inhalers remain the second most commonly prescribed first-line treatments (after LAMA monotherapy) across the range of COPD severities, because its use has been associated with an increased risk of pneumonia. [Pulm Pharmacol Ther 2017;42:1-6]