Fluticasone- vs Budesonide-Based Dual Therapy for COPD

Are different inhaled corticosteroid (ICS)–long-acting β-agonist (LABA) inhalers associated with different clinical outcomes among patients with chronic obstructive pulmonary disease (COPD)?In this cohort study of new ICS-LABA users, the dry powder inhaler fluticasone furoate–vilanterol was associated with a 9% lower risk of first moderate or severe COPD exacerbation compared with the metered-dose inhaler budesonide-formoterol and a 6% lower risk compared with the dry powder inhaler fluticasone propionate–salmeterol. Fluticasone propionate–salmeterol and budesonide-formoterol were associated with clinical outcomes that were similar to one another.These findings suggest that dry powder fluticasone-containing ICS-LABAs, which generate less than one-twentieth the greenhouse gas emissions of metered-dose formulations, have similar or slightly improved clinical outcomes compared with budesonide-formoterol among new users with COPD.

Corresponding Author: William B. Feldman, MD, DPhil, MPH, Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology, and Allergy, Department of Medicine, University of California, Los Angeles, 200 Medical Plaza, Suite 365, Los Angeles, CA 90095 (wfeldman@mednet.ucla.edu).

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