[Inhaled corticosteroid/beta-2 agonist therapy in moderate COPD]

Abstract

Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline defines moderate chronic obstructive pulmonary disease (COPD) as cases with postbronchodilator FEV(1) values between 80-50%. Guidelines list their expectations of COPD treatment as improvement in quality of life and functions, slowing functional progression, decreasing and treatment of exacerbations and complications and reduction in mortality. Guidelines, specifically the more commonly used GOLD guideline, recommends regular use of long acting bronchodilators alone or in combinations in symptomatic moderate COPD patients. Inhalation route is preferred. Use of salmeterol in symptomatic moderate COPD cases has increased FEV(1) and slowed down annual functional progression. Use of tiotropium as a single agent in the beginning of the study has improved quality of life, increased FEV(1), showed no effect on total number of exacerbations but reduced the number of exacerbations requiring hospitalization; however among patients treated with tiotropium alone, ICS + LABA, ICS alone and LABA alone had to be added to the treatment in 23%, 24% and 28% of the patients respectively. Only 37% of the patients did not need any additional treatment. Addition of tiotropium to a previous treatment has also improved quality of life and FEV(1) values. Bronchodilators have failed to meet the treatment expectations defined in guidelines in moderate COPD patients. Fixed combinations of inhaler corticosteroids and long acting beta agonists caused an improvement of -3.7 units in quality of life which is statistically insignificant but clinically very close to significance. Fixed combinations also managed to increase FEV(1), to slow down annual functional progression and to reduce total number of exacerbations and mortality which were all clinically and statistically significant. Use of ICS/LABA combinations, in which the components potentialize each other and which meet all of the expectations defined for COPD treatment, in bronchodilator and anti-inflammatory treatment promises to be a wise choice.