LAMA-LABA was associated with fewer chronic obstructive pulmonary disease exacerbations and pneumonia hospitalisations than was corticosteroid plus LABA.

Current guidelines recommend inhalers containing a long-acting antimuscarinic antagonist (LAMA) plus a long-acting beta-agonist (LABA) over inhalers containing an inhaled corticosteroid (ICS) plus a LABA for patients with chronic obstructive pulmonary disease (COPD; NEJM JW Gen Med May 15 2023 and Am J Respir Crit Care Med 2023; 207: 819-837). Indeed, trials have shown that combined LAMA-LABA treatment prevents COPD exacerbations more effectively than does ICS-LABA treatment. However, the same trials have reported mixed results regarding pneumonia. Using a large insurance claims database, researchers conducted this study of 31,000 propensity score–matched patient pairs (mean age, 70 years) with COPD who filled new prescriptions for LAMA-LABA or ICS-LABA inhalers from 2014 through 2019. Patients were followed for one year.

Compared with ICS-LABA treatment, LAMA-LABA treatment was associated with significantly fewer (by 8%) first moderate or severe COPD exacerbations (i.e. requiring oral corticosteroid treatment for five to 14 days or hospitalisation, respectively) and significantly fewer first pneumonia hospitalisations (by 20%). Subgroup and sensitivity analyses yielded similar results.

Comment: This observational study adds support for combined LAMA-LABA inhalers over ICS-LABA inhalers in patients with COPD. Limitations include the possibility of residual confounding and that analyses were based on prescription fills, not actual use. Additionally, LAMA- LABA and ICS-LABA were not compared with triple therapy (ICS-LAMA-LABA), which is an option for patients with inadequate response to dual-therapy and who have eosinophilia (NEJM JW Gen Med May 15 2020 and Chest 2020; 157: 846-855).

Paul S. Mueller, MD, MPH, FACP, Regional Vice President – Southwest Wisconsin, Mayo Clinic Health System, La Crosse; Professor of Medicine and Biomedical Ethics, Mayo Clinic College of Medicine and Science, Rochester, USA.

Feldman WB, et al. Chronic obstructive pulmonary disease exacerbations and pneumonia hospitalizations among new users of combination maintenance inhalers. JAMA Intern Med 2023 May 22; e-pub (https://doi.org/10.1001/jamainternmed. 2023.1245).

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.