Inhaled corticosteroids with combination inhaled long-acting beta2-agonists and long-acting muscarinic antagonists for chronic obstructive pulmonary disease

van Geffen, Wouter H; Tan, Daniel J; Walters, Julia AE; Walters, E Haydn

doi:10.1002/14651858.cd011600.pub3

Cited by 5 publications

(6 citation statements)

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“…Despite an increased risk of pneumonia in ICS treatment, there is no evidence of an associated increased pneumonia-related mortality [ 45 ]. While ICS treatment is associated with negative side effects, and potential overuse has been documented especially in patients with less severe COPD [ 2 , 46 ], ICS-containing treatment in patients with severe COPD has a well-documented effect on quality of life and exacerbation rate, and it may even reduce mortality [ 47 ]. We believe that our results reflect these real-world dilemmas, where the clinical cost–benefit analysis of ICS treatment is difficult.…”

Section: Discussionmentioning

confidence: 99%

“…However, this study design was necessary to estimate ICS doses. Furthermore, this study was not meant to assess causality between ICS treatment and pneumonia, as this relationship is already well established in studies better designed for this [ 4 , 47 ]. Finally, the lack of data on factors that could influence both ICS treatment and pneumonia is a limitation e.g.…”

Section: Discussionmentioning

confidence: 99%

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Inhaled corticosteroid treatment and pneumonia in patients with chronic obstructive pulmonary disease – nationwide development from 1998 to 2018

Klitgaard,

Ibsen,

Lykkegaard

et al. 2024

European Clinical Respiratory Journal

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Background A decreasing use of inhaled corticosteroids (ICS) in patients with a hospital-registered diagnosis of chronic obstructive pulmonary disease (COPD) has recently been documented in Denmark. ICS treatment is not recommended in patients with high pneumonia risk, and we aimed to assess the development of ICS treatment in relation to pneumonia occurrence. Methods Annual nationwide register-based cross-sectional studies from 1998 to 2018 including all patients ≥40 years of age with a hospital-registered ICD-10 diagnosis of COPD on the 31 st of December each year. We calculated the annual proportion of patients with at least one outpatient pneumonia (redeemed prescription of relevant antibiotics) or pneumonia hospitalization (hospitalization or ER visit), and stratified by ICS dose (No ICS, low dose, medium dose, or high dose). Results The study population increased from 35,656 patients in 1998 to 99,057 patients in 2018. The annual proportion of patients experiencing a pneumonia decreased from 69.4% to 55.2%. The proportion of patients with at least one outpatient pneumonia, but no hospitalization, decreased (59.2% to 46.2%). The overall proportion of patients with at least one pneumonia hospitalization remained unchanged (10.2% to 9.0%), but this proportion increased in patients in high dose ICS (9.9% to 14.6%). The overall proportion of patients in high dose treatment decreased (12.7% to 5.7%), but not in patients with pneumonia hospitalization (16.5% to 15.1). Conclusions Our study demonstrates a nationwide decrease from 1998 to 2018 in the proportion of patients who redeemed a prescription for antibiotics used mainly for respiratory tract infections, which may reflect a decrease in the number of outpatient pneumonias. This decrease was largely caused by an increase in the number of patients without pneumonia. No differences over time were seen regarding hospitalization-requiring pneumonia. High dose ICS treatment was unchanged in patients with hospitalization-requiring pneumonia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inhaled corticosteroid treatment and pneumonia in patients with chronic obstructive pulmonary disease – nationwide development from 1998 to 2018

Klitgaard,

Ibsen,

Lykkegaard

et al. 2024

European Clinical Respiratory Journal

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“…Management of chronic obstructive pulmonary disease (COPD) commonly involves a combination of long-acting bronchodilators including beta2-agonists (LABA) and muscarinic antagonists (LAMA). LABA and LAMA bronchodilators are now available in single-combination inhalers [4]. Additional SAMA on LABA could be a choice of treatment in a certain situation such as the on-demand use in COPD patients with exertional dyspnea [5].…”

Section: Introductionmentioning

confidence: 99%

A comparative study on safety profile and efficacy of salmeterol and tiotropium in COPD Patients

Kenchugundu Jagadeesh,

Rayachooti Vandana,

Bhyalla Akshay Varun

et al. 2024

World J. Adv. Res. Rev.

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Aim and Objectives: The aim of the study is assess the safety profile and efficacy of salmeterol and Tiotropium in patients with COPD. The objective is to compare to evaluate the safety profile and efficacy of salmeterol and Tiotropium in patients with COPD. Methodology: This was a prospective observational study conducted at secondary care hospital in India. In our study, we have included a total of 50 patients who are divided in to two groups based on their treatment and follow-ups was done for 12 weeks. Results: Patients were divided into 2 equal groups to receive salmeterol and Tiotropium (25 subjects each). The mean FEV1 level at baseline was 63.72±3.0210 for Tiotropium group and 64.96±1.645 for Salmeterol group and the mean FEV1 level after 12 weeks of treatment was 72.12±1.423 for Tiotropium group and 70.68±1.973 for Salmeterol group. Tiotropium treatment were associated with significant decrease in FEV1 level from baseline to 12 weeks. (P*<0.05). Conclusion: In our study, by performing the study, we concluded that tiotropium used once daily, produced superior bronchodilation and reduced dyspnea in patients with COPD when compared with salmeterol. Patients treated with tiotropium also indicated more improvement in their symptoms than those who treated with salmeterol. Because of these advantages, tiotropium should be considered first-line treatment in patients with COPD. While performing the safety parameters for a drug, side effects of tiotropium are less when compared to salmeterol.

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“…Inhaled corticosteroids (ICS) are the most commonly used anti-inflammatory drugs for the treatment of COPD. Although the use of ICS is known to increase the risk of respiratory infections, it has the benefit of reducing AE rate and improve quality of life 3 , 4 . Several recent randomized controlled trials (RCTs) and a meta-analysis have reported that inhaled therapy containing ICS reduces all-cause mortality in patients with COPD 3 – 8 .…”

Section: Introductionmentioning

confidence: 99%

“…Although the use of ICS is known to increase the risk of respiratory infections, it has the benefit of reducing AE rate and improve quality of life 3 , 4 . Several recent randomized controlled trials (RCTs) and a meta-analysis have reported that inhaled therapy containing ICS reduces all-cause mortality in patients with COPD 3 – 8 . Therefore, the Global Initiative for Chronic Obstructive Lung Disease guideline recommends adding ICS to LAMA and/or LABA in COPD patients with a history of frequent and/or severe exacerbations, high blood eosinophil count, and history of, or concomitant asthma 1 .…”

Section: Introductionmentioning

confidence: 99%

Survival benefit of inhaled corticosteroids in patients with chronic obstructive pulmonary disease: a nationwide cohort study

Shin,

Park,

Lee

et al. 2024

Sci Rep

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The role of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) is debated. We investigated whether the administration of ICS could lower the mortality risk in patients with COPD. We utilized the Korean National Health Insurance Service-National Sample Cohort database from 2002 to 2019. We included patients who had claim codes for COPD and inhalation respiratory medicine at least twice a year. A time-dependent Cox regression model was employed to estimate the association between ICS usage and survival. The cumulative dose of ICS was classified into three groups, and the mortality risk was compared among these groups. Of 16,463 included patients, there were 4395 (26.7%) deaths during the mean follow-up period of 5.0 years. The time-dependent Cox regression model demonstrated that ICS users had a significantly lower mortality risk compared to non-users (adjusted hazard ratio, 0.89; 95% CI, 0.83–0.94; p < 0.001), particularly among individuals aged ≥ 55 years, women, never smokers, and those with history of asthma or coronary heart disease. Higher cumulative dose groups were associated with a lower mortality risk compared to the lowest cumulative dose group. In conclusion, the administration of ICS seemed to be associated with a lower mortality risk in patients with COPD.

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Inhaled corticosteroids with combination inhaled long-acting beta2-agonists and long-acting muscarinic antagonists for chronic obstructive pulmonary disease

Abstract: Inhaled corticosteroids with combination inhaled long-acting beta 2 -agonists and long-acting muscarinic antagonists for chronic obstructive pulmonary disease.

Cited by 5 publications

References 73 publications

Inhaled corticosteroid treatment and pneumonia in patients with chronic obstructive pulmonary disease – nationwide development from 1998 to 2018

Inhaled corticosteroid treatment and pneumonia in patients with chronic obstructive pulmonary disease – nationwide development from 1998 to 2018

A comparative study on safety profile and efficacy of salmeterol and tiotropium in COPD Patients

Survival benefit of inhaled corticosteroids in patients with chronic obstructive pulmonary disease: a nationwide cohort study

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