ACP Journal Club. Review: corticosteroid plus LABA inhalers, vs LABAs alone, reduce morbidity in COPD.

Review scope Included studies compared combined ICS plus LABA (ICS/LABA) inhalers (fluticasone and salmeterol [FPS] or budesonide and formoterol [BDF]) with the same LABA alone in adults > 40 years of age who had stable COPD and had not had an exacerbation in the past month. Studies of patients who had partial reversibility on pulmonary function testing were included. Studies that included patients with asthma, cystic fibrosis, bronchiectasis, thoracic surgery, or other lung or significant diseases were excluded. Outcomes included mortality, exacerbation (as defined by individual studies, but usually ≥ 48 h of increased COPD symptoms requiring a change in treatment = moderate exacerbation) rate ratio, number of patients with ≥ 1 exacerbation, pneumonia, and health-related quality of life (St. George’s Respiratory Questionnaire [SGRQ], minimal clinically important difference 10 units).