The role of fluticasone propionate/salmeterol combination therapy in preventing exacerbations of COPD

Abstract

Exacerbations contribute significantly to the morbidity of COPD, leading to an accelerated decline in lung function, reduced functional status, reduced health status and quality of life, poorer prognosis and increased mortality. Prevention of exacerbations is thus an important goal of COPD management. In patients with COPD, treatment with a combination of the inhaled corticosteroid fluticasone propionate (250 microg) and the long-acting beta(2)-agonist salmeterol (50 microg) in a single inhaler (250/50 microg) is an effective therapy option that has been shown to reduce the frequency of exacerbations, to improve lung function, dyspnea and health status, and to be relatively cost-effective as a COPD maintenance therapy. Importantly, results of various studies suggest that fluticasone propionate and salmeterol have synergistic effects when administered together that improve their efficacy in controlling symptoms and reducing exacerbations. The present non-systematic review summarizes the role of fluticasone propionate/salmeterol combination therapy in the prevention of exacerbations of COPD and its related effects on lung function, survival, health status, and healthcare costs.

Keywords: Advair; COPD; combination drug therapy; disease exacerbation; fluticasone propionate; salmeterol.

Figure 1

(A) Reprinted with permission from Anzueto A, Ferguson GT, Feldman G, Chinksy K, et al. Effect of fluticasone propionate/salmeterol (250/50) on COPD exacerbations and impact on patient outcomes. COPD. 2009;6(5):320–329. Copyright © 2009 Taylor & Francis. (B) Reprinted with permission from Ferguson GT, Anzueto A, Fei R, Emmett A, Knobil K, Kalberg C. Effect of fluticasone propionate/salmeterol (250/50 μg) or salmeterol (50 μg) on COPD exacerbations. Respir Med. 2008;102(8): 1099–1108. Copyright © 2008 Elsevier.

Figure 2

Estimated prevalence of hospital discharges with selected comorbidities in patients with and without COPD. Notes: Bars represent the age-adjusted percentage with SE bars. Black bars show patients with COPD (either as primary or secondary discharge diagnosis). White bars show patients without any mention of a COPD discharge diagnosis. The prevalence of all listed comorbidities is different across COPD categories (P < 0.01). Abbreviations: IHD, ischemic heart disease; CHF, congestive heart failure; RF, respiratory failure; PVD, pulmonary vascular disease; TM, thoracic malignancy. Reprinted with permission from Holguin F, Folch E, Redd SC, Mannino DM. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001. Chest. 2005;128(4):2005–2011. Copyright © 2005 American College of Chest Physicians.