In spite of these indications, LABA/ICS inhalers remain the second most commonly prescribed first-line treatments (after LAMA monotherapy) across the range of COPD severities, because its use has been associated with an increased risk of pneumonia. On the other hand, LABA-ICS combinations are indicated for patients with severe-to-very-severe disease and a history of repeated exacerbations. Additionally, they prevent exacerbations and increase exercise endurance by reducing pulmonary hyperinflation and dyspnoea. Long-acting bronchodilator combinations (LAMA/LABA) have been identified as the initial drugs of choice for patients with more severe dyspnea, airflow obstruction, and hyperinflation. Use of LABA-LAMA inhalers are crucial to symptom management in COPD, improving lung function and health-related quality of life. As combination LABA/LAMA inhalers are now widely available, there is a need for welldesigned RCTs to investigate whether ICS provides any added therapeutic benefit. However, results for the incidence of severe pneumonia requiring hospitalization were better with LABA-LAMA (HR, 0.66 0.41–1.05), particularly in the on-treatment analysis (HR, 0.66 0.50–0.87). A lower dose, twice daily regimen for a LABA/LAMA has also been shown to improve. In multivariable Cox analysis the respective hazard ratios (HRs) for moderate and severe COPD exacerbations associated with LABA-LAMA initiation vs LABA-ICS initiation were 1.04 (95 percent CI, 0.90–1.20) and 0.94 (0.65–1.36). LABA/LAMA combinations are best evaluated on an individual patient basis. LAMA containing inhalers may have an advantage over those without a LAMA for preventing COPD exacerbations based on the rank statistics. There was no significant difference in the incidence of exacerbations between the two groups. The LABA/LAMA combination was the highest ranked treatment group to reduce COPD exacerbations although there was some uncertainty in the results. Researchers used data from the United Kingdom’s Clinical Practice Research Datalink and identified 1,977 initiators of LABA-LAMA and 1,977 matched initiators of LABA-ICS.Īll patients were aged ≥55 years and followed for 12 months for the occurrence of a moderate or severe COPD exacerbation and severe pneumonia. Long-acting beta 2-agonist (LABA) plus long-acting muscarinic antagonist (LAMA) combinations compare with inhalers containing both LABA and corticosteroid (LABA-ICS) in terms of reducing chronic obstructive pulmonary disease (COPD) exacerbations, although the LAMA-LABA combination is more favourable as it is associated with fewer episodes of severe pneumonia, according to a study.
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