COPD combination benefits questioned

Respiratory disease - Research suggests combination therapy does not offer additional benefits in lung disease.

Combination therapy for COPD was thought to give additional benefits

Adding long-acting beta- agonists (LABAs) to corticosteroid therapy for COPD does not appear to offer additional benefits, Dutch research has suggested.

The latest findings go against a recent analysis of the TORCH trial which found that combination therapy could help to reduce COPD exacerbations.

The Dutch study randomly assigned 114 steroid-naive patients or former smokers with moderate to severe COPD to one of four treatment groups.

The groups were given the inhaled corticosteroid (ICS) fluticasone for six months; fluticasone for 30 months; fluticasone in combination with the LABA salmeterol for 30 months; or placebo.

The patients were followed up for two-and-a-half years during which time the researchers noted any symptoms of COPD, performed spirometry and checked adherence to medication by counting the doses in the inhalers.

At the end of the study, the researchers found that treatment with fluticasone had helped to reduce the decline in lung function and improved airway hyper-responsiveness and overall health status.

But combination therapy did not provide further anti-inflammatory effects compared with fluticasone alone. Addition of salmeterol had no incremental effect on bronchial epithelial parameters or sputum inflammatory cells.

Combination therapy did, however, improve the level of FEV1 without further influencing lung function decline.

The researchers, led by Dr Therese Lapperre from Leiden University Medical Centre in Groningen, said that the improvement in the level of FEV1 with combination therapy may be down to a residual bronchodilator effect of salmeterol and not further disease modification.

They concluded: 'ICS decreases inflammation and can attenuate decline in lung function in steroid-naive patients with moderate to severe COPD.

'Adding LABAs does not enhance the effects of ICS therapy.'

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