Combination Therapy Recommended for Older Adults with COPD-Asthma

Older adults with chronic obstructive pulmonary disease (COPD), particularly those with asthma, may fare better with combination therapy than with long-acting beta-agonists (LABAs) alone, according to a new study in JAMA.

Patients who were taking a newly prescribed combination of LABAs and inhaled corticosteroids (ICS) had a lower rate of COPD hospitalizations and lower risk of death than patients who took newly prescribed LABAs alone.
___________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
New COPD Drug Approved by FDA
Diagnosing Asthma-COPD Overlap Syndrome
___________________________________________________________________________________________________________________________________________________________________

“These findings should be confirmed in prospective randomized clinical trials; however, they do point to a medication regimen that likely benefits people with COPD—particularly those with asthma and COPD,” says lead study author Andrea Gershon, MD, MSc, a respirologist at Sunnybrook Health Sciences Centre and scientist at Sunnybrook Research Institute and the Institute for Clinical Evaluative Sciences in Toronto.

She says one of the challenges of treating patients with both asthma and COPD is that there is currently relatively little evidence to guide clinical decisions. This is because many studies of COPD medications excluded people with asthma, and many studies of asthma medications excluded people with COPD.

Gershon and her colleagues evaluated the outcomes of LABA/ICS therapy compared with LABAs alone in older COPD patients with other illnesses, including asthma. They conducted a population-based, longitudinal cohort study in Ontario, Canada, from 2003 to 2011, examining patients ages 66 or older who met a validated case definition of COPD.

They followed 8,712 new users of LABA/ICS therapy for a median of 2.7 years, and 3,160 new users of LABAs alone for a median of 2.5 years.

After analyzing the data, Gershon says the researchers came to three significant findings:

• Patients who were taking the LABA/ICS combination had a lower rate of COPD hospitalizations and mortality than patients taking LABAs alone.

• The incremental benefit of LABA/ICS over LABAs alone was found to be greater in people with both asthma and COPD.

• The incremental benefit of LABA/ICS over LABAs alone was found to be greater in people who were not already taking an inhaled long-acting anticholinergic.

“COPD is not considered to be particularly corticosteroid responsive, while asthma is,” Gershon says. “This might be the reason why the incremental benefit of LABA/ICS over LABAs alone was found to be greater in people with both asthma and COPD.”

While their findings offer better insight into treating patients with COPD and asthma as well as patients with COPD alone who don’t respond well to corticosteroids, Gershon and her colleagues plan to continue research in this area to expand the evidence base.

“I think there is still a lot of work to be done examining the comparative effectiveness and safety of COPD medications in people with COPD, including those who also have a codiagnosis of asthma,” Gershon says.

—Colleen Mullarkey

Reference

Gershon AS, Campitelli MA, Croxford R, Stanbrook MB, To T, Upshur R, et al. Combination long-acting β-agonists and inhaled corticosteroids compared with long-acting β-agonists alone in older adults with chronic obstructive pulmonary disease. JAMA. 2014 Sep 17;312(11):1114-21.