The effect of combination therapy of inhaled corticosteroids and long-acting beta2-agonists on acute exacerbation in moderate to severe COPD patients

Background: The role of combination therapy of inhaled corticosteroid (ICS) plus long-acting β₂-agonist (LABA) in asthma is well established, but nor much is known about this treatment in COPD. Recent studies have revealed that combining therapy is associated with fewer acute exacerbations in COPD, but in most of the studies, high-dose combination therapies have been employed. The current study assessed the effect of moderate or high dose combination therapy of ICS plus LABA on the frequency of acute exacerbations in COPD. Methods: Between January 1, 2001 and August 31, 2004, 46 patients with COPD (moderate, severe, very severe) were enrolled who received either fluticasone/salmeterol (flu/sal) 250μg /50μg twice a day (group A) or flu/sal 500μg /50μg twice a day (group B) for more than a year. We divided them into two groups depending on the dosage of ICS plus LABA Effect of drugs was compared based on the factors such as symptom aggravation, number of admission, and time to first exacerbation during a year after use. Results: Eleven of twenty six patients in group A (42.3%) experienced acute exacerbation and eleven of twenty patients in group B (55%) experienced acute exacerbation during 1 year. Mean exacerbation rate of Group A was 0.96 and Group B was 1.05. Mean admission rate was 0.15 and 0.30, respectively. There was no statistically significant difference of aggravation rate, number of administration and time to first exacerbation between the two treatment groups. Conclusion: There was no significant difference between moderate and high dose combined inhaler therapy to reduce acute exacerbation in COPD patients (moderate, severe, very severe). Hence, the effective dose of combination therapy needs further study in patients with COPD.