Effect of Fluticasone With and Without Salmeterol on Pulmonary Outcomes in Chronic Obstructive Pulmonary Disease

Abstract

ICS therapy decreases inflammation and can attenuate decline in lung function in steroid-naive patients with moderate to severe COPD. Adding LABAs does not enhance these effects. .

A new perspective on optimal care for patients with COPD

“…PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org data support the efficacy of existing pharmacological treatments on prevention of exacerbations, 5,6 together with some effect on lung function decline 7,8 and improved survival, 9 many clinicians remain sceptical. Additionally, non-pharmacological treatment options in secondary care -including pulmonary rehabilitation, lung volume reduction surgery, oxygen therapy and influenza vaccination -have successfully improved well-being and/or the prognosis of COPD, but are often not considered.…”

PDE4-inhibitors: A novel, targeted therapy for obstructive airways disease

“…More importantly, in this long-term study, there was no evidence of any additive or synergistic anti-inflammatory effect with combination therapy (salmeterol and fluticasone) [48]. In contrast, following combination therapy, there was an improvement in lung function, which was not seen with fluticasone monotherapy [48]. Therefore, the improvements in FEV1 seen with combination therapy of ICS and LABA can be explained by relaxation of airway smooth muscle rather than a consequence of a synergistic or additive anti-inflammatory action, as evidenced by the comparable changes in rates of decline in lung function between salmeterol versus combination therapy [49].…”

“…The number of pro-inflammatory cells (CD3+, CD4+, CD8+ T lymphocytes, macrophages, mast cells) in biopsies from 101 patients previously steroid-naïve (GOLD stages II and III) but who were treated with fluticasone showed a significant reduction in inflammatory cell numbers over a 2.5 year treatment period. As compared to placebo, the magnitude of the reduction in the number of COPDrelevant inflammatory cells in bronchial biopsies was approximately 25% at 6 months and 45 % at 30 months of treatment [48]. More importantly, in this long-term study, there was no evidence of any additive or synergistic anti-inflammatory effect with combination therapy (salmeterol and fluticasone) [48].…”

“…As compared to placebo, the magnitude of the reduction in the number of COPDrelevant inflammatory cells in bronchial biopsies was approximately 25% at 6 months and 45 % at 30 months of treatment [48]. More importantly, in this long-term study, there was no evidence of any additive or synergistic anti-inflammatory effect with combination therapy (salmeterol and fluticasone) [48]. In contrast, following combination therapy, there was an improvement in lung function, which was not seen with fluticasone monotherapy [48].…”

“…Although earlier studies showed that combination therapy was associated with anti-inflammatory activity [50] after 12-13 weeks of treatment, which may be superior to monotherapy with fluticasone [51], the clinical relevance of these effects is debatable in light of the lack of effect of this treatment on lung function parameters [51]. Interestingly, the effect of fluticasone monotherapy on airway neutrophil numbers is conflicting, with both reports of a reduction [48] and increase [52] and again, the differences could be due to the relatively short duration of treatment in a limited number of patients in these studies. Alternatively, there is evidence of a (relative) corticosteroid resistance in patients with COPD.…”