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The effect of adding inhaled corticosteroids to tiotropium and long-acting beta(2)-agonists for chronic obstructive pulmonary disease (Review)

Karner, C; Cates, CJ (2011) The effect of adding inhaled corticosteroids to tiotropium and long-acting beta(2)-agonists for chronic obstructive pulmonary disease (Review). COCHRANE DATABASE OF SYSTEMATIC REVIEWS (9). pp. 1-16. ISSN 1469-493X https://doi.org/10.1002/14651858.CD009039.pub2
SGUL Authors: Cates, Christopher Joseph

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Abstract

BackgroundLong-acting bronchodilators comprising long-acting beta(2)-agonists and the anticholinergic agent tiotropiumare commonly used, either on their own or in combination, for managing persistent symptoms of chronic obstructive pulmonary disease. Patients with severe chronic obstructive pulmonary disease who are symptomatic and who suffer repeated exacerbations are recommended to add inhaled corticosteroids to their bronchodilator treatment. However, the benefits and risks of adding inhaled corticosteroid to tiotropium and long-acting beta2-agonists for the treatment of chronic obstructive pulmonary disease are unclear.ObjectivesTo assess the relative effects of adding inhaled corticosteroids to tiotropium and long-acting beta2-agonists treatment in patients with chronic obstructive pulmonary disease.Search strategyWe searched the Cochrane Airways Group Specialised Register of trials (February 2011) and reference lists of articles.Selection criteriaWe included parallel group, randomised controlled trials of three months or longer comparing inhaled corticosteroid and long-acting beta(2)-agonist combination therapy in addition to inhaled tiotropium against tiotropium and long-acting beta2-agonist treatment for patients with chronic obstructive pulmonary disease (COPD).Data collection and analysisTwo review authors independently assessed trials for inclusion and then extracted data on trial quality and the outcome results. We contacted study authors for additional information. We collected information on adverse effects from the trials.Main resultsOne trial (293 patients) was identified comparing tiotropium in addition to inhaled corticosteroid and long-acting beta(2)-agonist combination therapy to tiotropium plus long-acting beta2-agonist. The study was of good methodological quality, however it suffered from high and uneven withdrawal rates between the treatment arms. There is currently insufficient evidence to know how much difference the addition of inhaled corticosteroids makes to people who are taking tiotropium and a long-acting beta(2)-agonist for COPD.Authors' conclusionsThe relative efficacy and safety of adding inhaled corticosteroid to tiotropium and a long-acting beta(2)-agonist for chronic obstructive pulmonary disease patients remains uncertain and additional trials are required to answer this question.

Item Type: Article
Additional Information: This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2011 Issue 9. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review. Karner C, Cates CJ. The effect of adding inhaled corticosteroids to tiotropium and long-acting beta2-agonists for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2011, Issue 9 Art. No.: CD009039. DOI: 10.1002/14651858.CD009039.pub2.
Keywords: Administration, Inhalation, Adrenal Cortex Hormones, Adrenergic beta-Agonists, Delayed-Action Preparations, Drug Therapy, Combination, Humans, Pulmonary Disease, Chronic Obstructive, Randomized Controlled Trials as Topic, Scopolamine Derivatives, Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, BETA-AGONISTS, STABLE COPD, THERAPY, SAFETY, EXACERBATIONS, PROPIONATE, SALMETEROL, EFFICACY, PLACEBO, TRIAL
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: COCHRANE DATABASE OF SYSTEMATIC REVIEWS
ISSN: 1469-493X
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Dates:
DateEvent
1 January 2011Published
Web of Science ID: WOS:000294642700056
URI: http://openaccess.sgul.ac.uk/id/eprint/2682
Publisher's version: https://doi.org/10.1002/14651858.CD009039.pub2

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