What is the Right Inhaler Combination for COPD Patients?

A new study suggests that patients with chronic obstructive pulmonary disease (COPD) should be treated with an inhaler combination containing long-acting muscarinic antagonists (LAMAs) and long-acting β-agonists (LABAs) instead of inhalers containing inhaled corticosteroids (ICSs) and LABAs. The findings appeared this week in JAMA Internal Medicine. 

COPD guidelines recommend LAMA-LABAs over ISC-LABAs; however, clinical trial data, as the researchers noted, “have been conflicting and raised concerns of generalizability.”

In this study, Drs. William B. Feldman, Jerry Avorn, and Aaron S. Kesselheim, assessed 30,216 matched pairs of COPD patients who had a filled out a new prescription of ICS-LABAs or LAMA-LABAs between January 1, 2014, and December 31, 2019. The primary outcome was defined as the first moderate or severe COPD exacerbation, and the primary safety outcome was first pneumonia hospitalization.

According to the results, LAMA-LABA use was associated with an 8% reduction in the rate of first moderate or severe COPD exacerbation compared with  ICS-LABA use  (HR=0.92; 95% CI, 0.89-0.96), as well as a 20% reduction in the rate of pneumonia hospitalization (HR=0.80; 95% CI, 0.75-0.86). The findings were robust across several subgroup analyses.

“In this cohort study, LAMA-LABA therapy was associated with improved clinical outcomes compared with ICS-LABA therapy, suggesting that LAMA-LABA therapy should be preferred for patients with COPD,” the researchers concluded.