Chronic obstructive pulmonary disease (COPD) is a lung disease which includes the conditions chronic bronchitis and emphysema. COPD is characterised by blockage or narrowing of the airways. The symptoms include breathlessness and a chronic cough. COPD is an irreversible disease that is usually brought on by airway irritants, such as smoking or inhaled dust.
Long-acting beta2-agonists and tiotropium are two types of inhaled medications that help widen the airways (bronchodilators) for up to 12 to 24 hours. These bronchodilators are commonly used to manage persistent symptoms of COPD. They can be used in combination or on their own. Patients with severe COPD who suffer ongoing worsening of symptoms are recommended to add anti-inflammatory inhaled corticosteroids to their bronchodilator treatment. However, the benefits and risks of adding inhaled corticosteroid to tiotropium and long-acting beta2-agonists for the treatment of COPD are unclear.
This review found one study, involving 293 patients, comparing the long-term efficacy and side effects of combining inhaled corticosteroid with tiotropium and a long-acting beta2-agonist. In this study there were not enough patients for us to be able to draw any firm conclusions as to whether combining inhaled corticosteroid with tiotropium and the long-acting beta2-agonist is better or worse than using only tiotropium and the long-acting beta2-agonist. More long-term studies need to be done in order to better understand the effect of treatment with inhaled corticosteroid, tiotropium and a long-acting beta2-agonist.