Abstract
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.
Original language | English |
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Pages (from-to) | 1163-1186 |
Number of pages | 24 |
Journal | International Journal of Chronic Obstructive Pulmonary Disease |
Volume | 9 |
DOIs | |
Publication status | Published - 17-Oct-2014 |
Keywords
- 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