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Combination therapy of inhaled steroids and long-acting beta2-agonists compared to inhaled steroids alone for people with COPD

Nannini L, Poole P, Milan SJ, Kesterton A
Published Online: 
30 August 2013

Combinations of two classes of medication (long-acting beta2-agonists (LABAs) and inhaled corticosteroids (ICS)) in one inhaler have been developed to treat people with COPD, as this may make it easier to take the medication. Three brands of combined inhaler are currently available: budesonide/formoterol (BDF-'Symbicort'), fluticasone propionate/salmeterol (FPS-'Advair' or 'Seretide') and mometasone furoate/formoterol (MF/F-'Dulera'). Both the ICS part and the LABA component of each inhaler are aimed at reducing flare-ups of COPD, which can be debilitating and costly. In addition, the LABA component may improve day-to-day symptoms such as breathlessness and exercise tolerance.

Our review found 15 studies that compared a combination of ICS/LABA with ICS alone. We found that on the whole, combination inhalers reduced the frequency of flare-ups (not including hospitalisations) compared with ICS alone. The studies showed that on average, the number of exacerbations per participant was reduced, as was the probability of death, during treatment. Quality of life and lung function showed improvement with combination treatment compared with ICS, but no difference between them was noted in terms of adverse effects, or the likelihood of having no flare-ups at all. Future research should assess the efficacy of BDF and MF/F because most evidence gathered to date, including for mortality, has been drawn from FPS studies.