Dr. Coursen
Clinical question: Is a long-acting beta agonist and long-acting muscarinic antagonist (LABA-LAMA) inhaler combination better than an inhaled corticosteroid and long-acting beta agonist (ICS-LABA) combination to improve clinical outcomes in patients with chronic obstructive pulmonary disease (COPD)?
Background: Clinical guidelines recommend LABA-LAMA over ICS-LABA in COPD patients but randomized clinical trials have shown mixed data on clinical outcomes comparing these maintenance combination inhalers.
Study design: Large retrospective cohort study
Setting: National insurance database
Synopsis: From a national insurance database, 30,216 pairs of COPD patients were identified as starting maintenance combination inhalers with either LABA-LAMA or ICS-LABA. Those with a prior diagnosis of asthma were excluded. LABA-LAMA showed improved clinical outcomes compared to ICS-LABA with a 20% reduction in first pneumonia hospitalization and an 8% reduction in moderate or severe COPD exacerbation. No difference was found in patients with higher eosinophil counts. Limitations included only one year of follow-up time. These results were overall consistent with findings from the 2016 FLAME trial.
Bottom line: A large retrospective cohort study demonstrated fewer COPD exacerbations and pneumonia hospitalizations for COPD patients initiated on LABA-LAMA as opposed to ICS-LABA for new start of maintenance combination inhalers.
Citation: Feldman WB, Avorn J, et al. Chronic obstructive pulmonary disease exacerbations and pneumonia hospitalizations among new users of combination maintenance inhalers. JAMA Intern Med. 2023;183(7):685-95.
Dr. Coursen is a hospitalist at Johns Hopkins Hospital and an assistant professor of medicine at Johns Hopkins University in Baltimore.