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    Combo Treatment Works Best for COPD

    Only Small Benefit Seen With Chronic Obstructive Pulmonary Disease Treatment

    Study Results

    A total of 875 patients died during the three-year study.

    Deaths from all causes occurred in 12.6% of the combination treatment group, 13.5% of the group treated with the long-acting beta-agonist alone, 16% of those treated with the inhaled corticosteroid alone, and 15.2% of the placebo group.

    Compared with no treatment, the combination treatment resulted in statistically meaningful improvements in lung function and less worsening of COPD-related symptoms.

    Treatment with inhaled corticosteroids -- either alone or as part of the combination therapy -- was associated with an increase in pneumonia in the newly reported study.

    Patients treated with either the combination therapy or the inhaled steroids alone were 60% more likely to be diagnosed with pneumonia. But, surprisingly, they were no more likely to die or be hospitalized than patients who did not receive corticosteroids.

    “We don’t really know what this means,” Calverley says. “These patients had more pneumonias, but on average they felt better and had fewer flare-ups of their disease than [untreated] patients.”

    Survival Advantage Probably Small

    Calverley says the high dropout rate in the untreated (placebo) patients -- 44% compared with 34% of the Advair-treated patients -- could help explain the failure to show a clear survival advantage in patients with the combination treatment.

    But pulmonary disease expert Klaus F. Rabe, MD, PhD, tells WebMD the new findings suggest that if a survival advantage exists, it is probably a small one.

    Rabe, a professor of medicine at Leiden University Medical Center in the Netherlands, is chairman of the science committee of the Global Initiative for Obstructive Lung Disease.

    “The hope had been that this would be a wonder drug that would stop people from dying of this disease, but that does not appear to be the case,” he says.

    In an editorial accompanying the study, Rabe concludes that COPD patients should not be treated with inhaled corticosteroids alone.

    “Combination therapy, as compared with monotherapy with long-acting beta-agonists or inhaled corticosteroids, offers statistically significant advantages for health status, frequency of exacerbations, use of oral steroids, and -- probably most important clinically -- protection against a decline in lung function,” he wrote.

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