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COPD Best Treated with Combination Drug
- Updated: September 18, 2014
A new study finds that a combination drug therapy designed to open the airways and reduce inflammation may be the best treatment for older adults living with Chronic Obstructive Pulmonary Disease or COPD, specifically in people with asthma.
Published in the Journal of the American Medical Association (JAMA), Canadian researchers discovered that patients with COPD who received a combination of inhaled corticosteroids and long-acting beta agonists had a reduced risk of dying or incidents of hospitalization compared to those who receive just one of these medications.
This study involved Canadian government health data on approximately 12,000 people with COPD during the timeframe from 2003 to 2011. Included were 8,712 patients who had only recently started taking the combination therapy along with 3,160 patients who had just started taking long-acting beta agonists.
These records consisted of real-life situations involving doctors who treated COPD patients using their best judgment. Dr. Norman Edelman, senior medical advisor to the American Lung Association, stated that performing a drug trial and using select patients is one thing in determining how well a drug works but when reviewing data gathered over a period of time to see how these patients did in life by working with real doctors was very different.
Close to 37.3% of the people taking only long-acting beta agonists died compared to 36.4% of those using the combination drugs. For hospitalizations due to COPD, the results were similar. In this case approximately 30.1% or patients on a single drug died compared to 27.8% of patients on the combination therapy.
The combination therapy showed a reduced risk of death or hospitalization by 3.7% in comparison with just the long-acting beta agonists. However, the most significant difference was that for patients with COPD and those diagnosed with asthma, reduced risk of death or hospitalization was 6.5% by using the combination therapy rather than just a single drug.
One thing noted by researchers was that for people who used inhaled long-acting anticholinergic medication for a long period of time, the combination therapy was not as effective. On the other hand, patients given the combination therapy but had never been on inhaled long-acting anticholinergic medication, risk of death or hospitalization was 8.4%.
Dr. Andrea Gershon, scientist with the Institute for Clinical Evaluative Sciences and the Sunnybrook Health Sciences Center in Toronto Canada states that the official guidelines used to treat patients with COPD are quite different from what this study suggests although the combination treatment is something often used in clinics by reputable chest doctors.
In the current guidelines for treating COPD, patients are given a long-acting beta agonist first. This particular drug helps relax but also widen airways, thereby making it easier for patients to breath. Then, if that treatment fails, an inhaled corticosteroid to help reduce inflammation can be added.
However, as Gershon says, combination therapy consisting of the two drugs has been shown to be far more effective. She was not sure why so many chest doctors are now treating COPD patients this way, believing it could have something to do with strong intuition or good marketing strategies.
In addition to this finding, researchers learned that there was no increased risk of side effects from either drug when given in combination form, especially pneumonia and osteoporosis. Dr. Norman Edelman, senior medical advisor to the American Lung Association suspects after medical professionals read the report from this latest study that more will begin using the combination therapy opposed to following current guidelines.
Dr. Darcy Marciniuk, former president of the American College of Chest Physicians and the head of the division of respirology, critical care, and sleep medicine at the University of Sadkatchewan hopes that more doctors will be encouraged to offer COPD patients the combination therapy opposed to just one medication.
Marciniuk stated that about 10 times more new COPD patients are now being given the combination therapy, which speaks volumes.