Long-Acting Bronchodilators With or Without Inhaled Steroids in COPD

Long-acting β-agonists (e.g., salmeterol, formoterol) or anticholinergics (e.g., tiotropium) are recommended initially for patients with chronic obstructive pulmonary disease who have persistent symptoms and require bronchodilator therapy. The addition of inhaled corticosteroids is recommended for patients with repeated exacerbations. In this meta-analysis, researchers examined the incremental benefits and harms of adding inhaled corticosteroids; they identified 18 randomized trials (involving 12,446 patients) in which salmeterol was compared with salmeterol/fluticasone or in which formoterol was compared with formoterol/budesonide. Duration of trials ranged from 2 to 36 months.

Compared with monotherapy, combination therapy lowered risk for…