The Role of Combination Therapy with Corticosteroids and Long-acting Beta2-agonists in the Prevention of Exacerbations in COPD

Overview

Journal Int J Chron Obstruct Pulmon Dis

Publisher Dove Medical Press

Specialty Pulmonary Medicine

Date 2007 Nov 30

PMID 18044091

Citations 9

Authors

Mario Cazzola

Nicola A Hanania

Affiliations

Soon will be listed here.

Abstract

Acute exacerbations of COPD can complicate the course of the disease in patients with severe airway obstruction. Reduction of exacerbations is an important clinical outcome in evaluating new therapies in COPD. Combination therapies with long-acting beta-agonists and inhaled corticosteroids have now been approved for use. Three 1-year randomized clinical trials, which studied the effect of combining a long-acting beta2-agonist with an inhaled corticosteroid in COPD, documented that exacerbation frequency was lower with therapy than placebo. Combination therapy had a similar effect to its monocomponents in the trial evaluating salmeterol/fluticasone combination. However, when patients with more severe COPD were studied using a combination of budesonide and formoterol, a clear improvement was seen in the overall exacerbation rates compared with the use of a long-acting beta2-agonist alone.

Citing Articles

Prednisone-hydrogen sulfide releasing hybrid shows improved therapeutic profile in asthma.

Cerqua I, Granato E, Corvino A, Severino B, DAvino D, Simonelli M Front Pharmacol. 2023; 14:1266934.

PMID: 37900172 PMC: 10602694. DOI: 10.3389/fphar.2023.1266934.

Role of Tiotropium in Reducing Exacerbations of Chronic Obstructive Pulmonary Disease When Combined With Long-Acting β -Agonists and Inhaled Corticosteroids: The OUTPUL Study.

Ferroni E, Belleudi V, Cascini S, Di Martino M, Kirchmayer U, Pistelli R J Clin Pharmacol. 2016; 56(11):1423-1432.

PMID: 27095425 PMC: 5111769. DOI: 10.1002/jcph.750.

Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population.

Pasquale M, Sun S, Song F, Hartnett H, Stemkowski S Int J Chron Obstruct Pulmon Dis. 2012; 7:757-64.

PMID: 23152680 PMC: 3496536. DOI: 10.2147/COPD.S36997.

The effects of extracellular matrix proteins on neutrophil-endothelial interaction--a roadway to multiple therapeutic opportunities.

Padmanabhan J, Gonzalez A Yale J Biol Med. 2012; 85(2):167-85.

PMID: 22737047 PMC: 3375712.

Bronchoprotection in conscious guinea pigs by budesonide and the NO-donating analogue, TPI 1020, alone and combined with tiotropium or formoterol.

Turner D, Ferrari N, Ford W, Kidd E, Nevin B, Paquet L Br J Pharmacol. 2012; 167(3):515-26.

PMID: 22563753 PMC: 3449257. DOI: 10.1111/j.1476-5381.2012.02016.x.

References

Barnes N, Qiu Y, Pavord I, Parker D, Davis P, Zhu J . Antiinflammatory effects of salmeterol/fluticasone propionate in chronic obstructive lung disease. Am J Respir Crit Care Med. 2006; 173(7):736-43. DOI: 10.1164/rccm.200508-1321OC. View

Jones P . Clinical effects of inhaled corticosteroids in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005; 1(3):167-70. DOI: 10.1513/pats.200402-012MS. View

Halpin D . Evaluating the effectiveness of combination therapy to prevent COPD exacerbations: the value of NNT analysis. Int J Clin Pract. 2005; 59(10):1187-94. DOI: 10.1111/j.1368-5031.2005.00664.x. View

Seemungal T, Bhowmik A, Moric I, SANDERSON G, Message S, MacCallum P . Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001; 164(9):1618-23. DOI: 10.1164/ajrccm.164.9.2105011. View

Dowling R, Johnson M, COLE P, Wilson R . Effect of fluticasone propionate and salmeterol on Pseudomonas aeruginosa infection of the respiratory mucosa in vitro. Eur Respir J. 1999; 14(2):363-9. DOI: 10.1034/j.1399-3003.1999.14b21.x. View

Tse R, Marroquin B, Dorscheid D, White S . Beta-adrenergic agonists inhibit corticosteroid-induced apoptosis of airway epithelial cells. Am J Physiol Lung Cell Mol Physiol. 2003; 285(2):L393-404. DOI: 10.1152/ajplung.00030.2003. View

Hanania N, Darken P, Horstman D, Reisner C, Lee B, Davis S . The efficacy and safety of fluticasone propionate (250 microg)/salmeterol (50 microg) combined in the Diskus inhaler for the treatment of COPD. Chest. 2003; 124(3):834-43. DOI: 10.1378/chest.124.3.834. View

Calverley P, Pauwels R, Vestbo J, Jones P, Pride N, Gulsvik A . Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial. Lancet. 2003; 361(9356):449-56. DOI: 10.1016/S0140-6736(03)12459-2. View

Calverley P, Boonsawat W, Cseke Z, Zhong N, Peterson S, Olsson H . Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Respir J. 2003; 22(6):912-9. DOI: 10.1183/09031936.03.00027003. View

10.

Szafranski W, Cukier A, Ramirez A, Menga G, Sansores R, Nahabedian S . Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J. 2003; 21(1):74-81. DOI: 10.1183/09031936.03.00031402. View

11.

Calverley P . Reducing the frequency and severity of exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005; 1(2):121-4. DOI: 10.1513/pats.2306031. View

12.

Barnes P . Corticosteroid resistance in airway disease. Proc Am Thorac Soc. 2005; 1(3):264-8. DOI: 10.1513/pats.200402-014MS. View

13.

Martinez F, Anzueto A . Appropriate outpatient treatment of acute bacterial exacerbations of chronic bronchitis. Am J Med. 2005; 118 Suppl 7A:39S-44S. DOI: 10.1016/j.amjmed.2005.05.012. View

14.

Jones P, Willits L, Burge P, Calverley P . Disease severity and the effect of fluticasone propionate on chronic obstructive pulmonary disease exacerbations. Eur Respir J. 2003; 21(1):68-73. DOI: 10.1183/09031936.03.00013303. View

15.

Nannini L, Cates C, Lasserson T, Poole P . Combined corticosteroid and long acting beta-agonist in one inhaler for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004; (3):CD003794. DOI: 10.1002/14651858.CD003794.pub2. View

16.

Paul Man S, Sin D . Inhaled corticosteroids in chronic obstructive pulmonary disease: is there a clinical benefit?. Drugs. 2005; 65(5):579-91. DOI: 10.2165/00003495-200565050-00001. View

17.

van der Valk P, Monninkhof E, van der Palen J, Zielhuis G, van Herwaarden C . Effect of discontinuation of inhaled corticosteroids in patients with chronic obstructive pulmonary disease: the COPE study. Am J Respir Crit Care Med. 2002; 166(10):1358-63. DOI: 10.1164/rccm.200206-512OC. View

18.

Rennard S . Treatment of stable chronic obstructive pulmonary disease. Lancet. 2004; 364(9436):791-802. DOI: 10.1016/S0140-6736(04)16941-9. View

19.

Haughney J, Gruffydd-Jones K . Patient-centred outcomes in primary care management of COPD - what do recent clinical trial data tell us?. Prim Care Respir J. 2006; 13(4):185-97. PMC: 6750695. DOI: 10.1016/j.pcrj.2004.06.006. View

20.

Mahler D, Wire P, Horstman D, Chang C, Yates J, Fischer T . Effectiveness of fluticasone propionate and salmeterol combination delivered via the Diskus device in the treatment of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002; 166(8):1084-91. DOI: 10.1164/rccm.2112055. View