Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPDPostma, D. S., Roche, N., Colice, G., Israel, E., Martin, R. J., van Aalderen, W. M. C., Grigg, J., Burden, A., Hillyer, E. V., von Ziegenweidt, J., Gopalan, G. & Price, D., 17-Oct-2014, In : International Journal of Chronic Obstructive Pulmonary Disease. 9, p. 1163-1186 24 p.
Research output: Contribution to journal › Article › Academic › peer-review
Purpose: Small airway changes and dysfunction contribute importantly to airway obstruction in chronic obstructive pulmonary disease (COPD), which is currently treated with inhaled corticosteroids (ICS) and long-acting bronchodilators at Global initiative for Obstructive Lung Disease (GOLD) grades 2-4. This retrospective matched cohort analysis compared effectiveness of a representative small-particle ICS (extrafine beclomethasone) and larger-particle ICS (fluticasone) in primary care patients with COPD.
Patients and methods: Smokers and ex-smokers with COPD >= 40 years old initiating or stepping-up their dose of extrafine beclomethasone or fluticasone were matched 1:1 for demographic characteristics, index prescription year, concomitant therapies, and disease severity during 1 baseline year. During 2 subsequent years, we evaluated treatment change and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection.
Results: Mean patient age was 67 years, 57%-60% being male. For both initiation (n=334:334) and step-up (n=189:189) patients, exacerbation rates were comparable between extrafine beclomethasone and fluticasone cohorts during the 2 year outcome period. Odds of treatment stability (no exacerbation or treatment change) were significantly greater for patients initiating extrafine beclomethasone compared with fluticasone (adjusted odds ratio 2.50; 95% confidence interval, 1.32-4.73). Median ICS dose exposure during 2 outcome years was significantly lower (P
Conclusion: We observed that small-particle ICS at significantly lower doses had comparable effects on exacerbation rates as larger-particle ICS at higher doses, whereas initiation of small-particle ICS was associated with better odds of treatment stability during 2-years' follow-up.
|Number of pages||24|
|Journal||International Journal of Chronic Obstructive Pulmonary Disease|
|Publication status||Published - 17-Oct-2014|
- COPD exacerbation, extrafine particle, matched cohort analysis, real life, small airways, OBSTRUCTIVE PULMONARY-DISEASE, RANDOMIZED CONTROLLED-TRIAL, SMALL-AIRWAY OBSTRUCTION, HYDROFLUOROALKANE-134A BECLOMETHASONE, LUNG DEPOSITION, FLUTICASONE, ASTHMA, COMBINATION, SALMETEROL, MANAGEMENT