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Meta-Analysis
. 2010 May 11;11(1):56.
doi: 10.1186/1465-9921-11-56.

The effects of long-acting bronchodilators on total mortality in patients with stable chronic obstructive pulmonary disease

Agnes Kliber  1 , Larry D Lynd, Don D Sin
Affiliations
Meta-Analysis

The effects of long-acting bronchodilators on total mortality in patients with stable chronic obstructive pulmonary disease

Agnes Kliber et al. Respir Res. .

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is the 4th leading cause of mortality worldwide. Long-acting bronchodilators are considered first line therapies for patients with COPD but their effects on mortality are not well known. We performed a comprehensive systematic review and meta-analysis to evaluate the effects of long-acting bronchodilators on total mortality in stable COPD.

Methods: Using MEDLINE, EMBASE and Cochrane Systematic Review databases, we identified high quality randomized controlled trials of tiotropium, formoterol, salmeterol, formoterol/budesonide or salmeterol/fluticasone in COPD that had a follow-up of 6 months or longer and reported on total mortality. Two reviewers independently abstracted data from the original trials and disagreements were resolved by iteration and consensus.

Results: Twenty-seven trials that included 30,495 patients were included in the review. Relative risk (RR) for total mortality was calculated for each of the study and pooled together using a random-effects model. The combination of inhaled corticosteroid (ICS) and long-acting beta-2 agonist (LABA) therapy was associated with reduced total mortality compared with placebo (RR, 0.80; p = 0.005). Neither tiotropium (RR, 1.08; p = 0.61) nor LABA by itself (RR, 0.90; p = 0.21) was associated with mortality.

Conclusions: A combination of ICS and LABA reduced mortality by approximately 20%. Neither tiotropium nor LABA by itself modifies all-cause mortality in COPD.

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Figures

Figure 1
Figure 1
Flow Diagram Outlining the Search Strategy.
Figure 2
Figure 2
The Effects of Inhaled Corticosteroid/Long-Acting Beta-2 Agonist Combination on Total Mortality. Abbreviations: BUD/F, budesonide/formoterol combination; CI, confidence interval; ICS/LABA, inhaled corticosteroids/long-acting beta-2 agonist combination; M-H, Mantel-Hanzel; SALM, salmeterol; SFC, salmeterol/fluticasone combination
Figure 3
Figure 3
The Effects of Inhaled Corticosteroid/Long-Acting Beta-2 Agonist Combination on Total Mortality Excluding Calverley et al's Trial [13]. Abbreviations: BUD/F, budesonide/formoterol combination; CI, confidence interval; ICS/LABA, inhaled corticosteroids/long-acting beta-2 agonist combination; M-H, Mantel-Hanzel; SALM, salmeterol; SFC, salmeterol/fluticasone combination
Figure 4
Figure 4
The Effects of Inhaled Corticosteroid/Long-Acting Beta-2 Agonist Combination on Total Mortality Using Clinical Trials That Used Placebo-Treated Patients As The Main Comparator. Abbreviations: BUD/F, budesonide/formoterol combination; CI, confidence interval; ICS/LABA, inhaled corticosteroids/long-acting beta-2 agonist combination; M-H, Mantel-Hanzel; SALM, salmeterol; SFC, salmeterol/fluticasone combination
Figure 5
Figure 5
The Effects of Long-Acting Beta-2 Agonists on Total Mortality. Abbreviations: CI, confidence interval; FORM, formoterol; LABA; long-acting beta-2 agonists; M-H, Mantel-Hanzel; SALM, salmeterol
Figure 6
Figure 6
The Effects of Tiotropium on Total Mortality. Abbreviations: CI, confidence interval; ICS/LABA, inhaled corticosteroids/long-acting beta-2 agonist combination; M-H, Mantel-Hanzel
Figure 7
Figure 7
The Effects of Tiotropium on Total Mortality Using Clinical Trials That Used Placebo or Ipratropium Bromide As The Main Comparator. Abbreviations: CI, confidence interval; ICS/LABA, inhaled corticosteroids/long-acting beta-2 agonist combination; M-H, Mantel-Hanzel
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References

    1. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997;349(9063):1436–1442. doi: 10.1016/S0140-6736(96)07495-8. - DOI - PubMed
    1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997;349(9064):1498–1504. doi: 10.1016/S0140-6736(96)07492-2. - DOI - PubMed
    1. O'Donnell DE, Aaron S, Bourbeau J, Hernandez P, Marciniuk DD, Balter M, Ford G, Gervais A, Goldstein R, Hodder R, Kaplan A, Keenan S, Lacasse Y, Maltais F, Road J, Rocker G, Sin D, Sinuff T, Voduc N. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2007 update. Can Respir J. 2007;14(Suppl B):5B–32B. - PMC - PubMed
    1. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532–555. doi: 10.1164/rccm.200703-456SO. - DOI - PubMed
    1. Barr RG, Bourbeau J, Camargo CA, Ram FS. Tiotropium for stable chronic obstructive pulmonary disease: A meta-analysis. Thorax. 2006;61(10):854–862. doi: 10.1136/thx.2006.063271. - DOI - PMC - PubMed

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