The team conducted a double-blind randomised trial comparing indacterol-glycopyrronium – a LABA-LAMA combination – with a LAMA and inhaled corticosteroid combination in salmeterol-fluticasone to assess the effect of each combination on the number of COPD exacerbations over the course of a year.Ĭurrent NICE guidelines recommend GPs offer a LABA with either an inhaled corticosteroid or a LAMA to patients who are breathless or suffer exacerbations despite using a SABA, and who have an FEV 1 <50%. Pneumonia incidence was also significantly lower in the group LABA-LAMA group – at 3.2% compared to 4.8% in patients taking salmeterol-fluticasone. The indacterol-glycopyrronium group also experienced a significantly longer time to their first COPD exacerbation – 71 days versus 51 – and a 17% reduction in the rate of moderate or severe exacerbations. Rationale: There is uncertainty on the optimal first-line therapy for symptomatic chronic obstructive pulmonary disease (COPD). In patients with COPD, LABA/LAMA compared with ICS/LABA, there were no differences between umeclidinium bromide (UME)/vilanterol (VIL) and FP/SAL. In the network meta-analysis, LAMA/LABA inhalers decreased the rate of moderate to severe exacerbations compared to ICS/LABA (HR 0.86, 95 credible interval (CrI) 0.76 to 0.99), LAMA (HR 0. The Global Initiative for Chronic Obstructive Lung Disease 2022 report recommends initial pharmacological treatment. had shorter time to treatment failure than ICS/LABA in patients with asthma. A network meta-analysis was undertaken for dual combination inhalers compared with single-agent long-acting bronchodilators ( Oba 2018) evidence level I. These findings were statistically significant and were reproduced in the smaller matched cohort. Inhaled bronchodilators (alone or in combination) are the cornerstone of treatment for symptomatic patients with COPD, either as initial/first-line treatment or for second-line/treatment escalation in patients who experience persistent symptoms or exacerbations on monotherapy. The interval before progression to triple therapy also was longer in the LABA/LAMA group. 3, 4 Consider adding theophylline in patients with severe COPD for whom other treatments have failed to control symptoms adequately. Patients receiving a combination of indacterol-glycopyrronium experienced 11% fewer exacerbations over the year than patients taking salmeterol-fluticasone. The mean time to first exacerbation in the LABA/ICS group was 6.03 months (95 CI, 5.94-6.12) vs 6.40 months (95 CI, 6.21-6.59) in the LABA/LAMA group ( P <.001). There is some evidence to support triple therapy (LABA + LAMA + ICS) improving lung function and quality of life, but more studies are required. The benefits of triple therapy for chronic obstructive pulmonary disease (COPD). Using a LABA in combination with a LAMA rather than an inhaled corticosteroid to treat COPD is more effective in preventing exacerbations, according to a study.
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