Is the combination of a corticosteroid and long-acting beta-agonist in one inhaler more effective than long-acting beta-agonists alone for chronic obstructive pulmonary disease (COPD)?
Inhaled steroids for COPD carry an increased risk of pneumonia (a relative increase of around 50 per cent). In the TORCH study with rates of pneumonia of 20 per cent over 3 years in this population, the NNH** was 12. In another study with rates of 2 per cent over one year the NNH was 84.This needs further study to determine the clinical relevance as the Cochrane review does not show an increase in exacerbations or deaths despite the increase in pneumonia. **NNH = number needed to treat to cause harm in one individual.
Combinations of 2 classes of medication in one inhaler have been developed to treat people with COPD as this may make it easier to take the medications than using 2 separate inhalers. Two types of combined inhaler exist currently: budesonide/formoterol (BDF – “Symbicort”) and fluticasone/salmeterol (FPS – “Advair” “Viani” or “Seretide”).