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Recent studies have suggested possible harm from long-acting β-agonists, but possible benefit from the combination of β-agonists and inhaled steroids (Journal Watch Dec 28 2006 and Feb 21 2007). This study, sponsored by the Canadian Institutes of Health, examined the treatment outcomes of 449 patients with moderate or severe chronic obstructive pulmonary disease; the patients all received tiotropium and were randomized to receive placebo, inhaled salmeterol, or fluticasone–salmeterol for 1 year.
Similar proportions of patients in all three groups (60%–65%) had COPD exacerbations, which were defined as a sustained worsening of respiratory condition requiring steroids or antibiotics. However, the tiotropium/fluticasone–salmeterol group (but no…