Reducing COPD exacerbations : LABA/ICS combination therapy vs LABA monotherapy

Abstract

Background: This review evaluates the pharmacological management of COPD regarding the efficacy of LABA monotherapy and LABA/ICS combination therapy on the rate of exacerbations of the disease. A research question was formulated: In adults with Chronic Obstructive Pulmonary Disease, is the use of long-acting β2-agonists in combination with inhaled corticosteroids more effective than the use of long-acting β2- agonists alone in reducing the rate of exacerbations? The PICO framework being: the Population including adults with COPD, the Intervention comprising of LABA combined with ICS, the Comparison encompassing LABA alone, and the Outcome is reducing the rate of exacerbations. Method: A literature search was carried out by searching through databases and reference lists. The inclusion criteria comprised of fulltext articles published in English between 2006 and 2016 in a peer reviewed journal, containing any specific LABA and ICS. Studies that included patients younger than 18 years old or who had asthma, comparing the outcome of any drugs other than LABA/ICS combination therapy with LABA monotherapy, unpublished articles, and secondary sources were excluded. Two meta-analyses, three systematic reviews and three RCTs were obtained and appraised using the relevant CASP tools. Findings suggest that combination therapy with LABA and ICS is more effective than monotherapy with LABA alone in decreasing the rate of moderate-to-severe exacerbations in patients over 40 years old with severe but stable COPD who have experienced at least one or frequent exacerbations. The identification of literature gaps suggests that further research is required. Implications and recommendations include the development of a standardised ‘exacerbation’ definition, evaluating the effects of the intervention and comparison immediately following an exacerbation, and educating patients and healthcare professionals regarding current research findings. Conclusion: Insight was gained regarding the importance of pharmacological management and EBP in the clinical setting.