Initial inhaler choice in COPD: Real-world evidence

Thomas Jones*

*Corresponding author for this work

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Long-acting bronchodilators are the mainstay of inhaled therapy in COPD. Both long-acting β-agonists (LABA) and long-acting muscarinic antagonists (LAMA) are effective at reducing breathlessness and exacerbation frequency, with LAMA being the more effective of the two classes [1]. The Global Initiative for Chronic Obstructive Lung Disease advises that inhaled corticosteroids (ICS) are reserved for those who exacerbate more frequently and preferably after the addition of dual long-acting bronchodilators [2]. Some people with COPD benefit from ICS, and there is evidence that blood eosinophil count is a useful biomarker to highlight who might benefit [3]. ICS are known to increase the risk of pneumonia in people with COPD [4] but despite the guidelines, many people with COPD are prescribed LABA/ICS combinations as initial inhaled therapy [5]. Suissa et al. [6] reported real-world evidence comparing LABA/ICS with LAMA as the initial treatment of COPD, stratified by blood eosinophil count, detailing both the benefits for exacerbation frequency and risk of pneumonia with each treatment strategy.

Original languageEnglish
Pages (from-to)350-352
Number of pages3
Issue number4
Publication statusPublished - 1 Dec 2019

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