Which Step-Up Drug Combination Is Preferred for Chronic Obstructive Pulmonary Disease Patients?

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines recommend the combination of a long-acting antimuscarinic (LAMA) agent and a long-acting β-agonist (LABA) in patients whose chronic obstructive pulmonary disease (COPD) is not controlled with a long-acting bronchodilator alone. Still, many clinicians first add an inhaled corticosteroid (ICS) to a LABA. Previous studies comparing the effectiveness of various step-up regimens have yielded conflicting results.

Using national U.K. clinical data, researchers matched 2000 COPD patients (mean age, 72) who started LABA/LAMA therapy with similar patients who contemporaneously started LABA/ICS. Patients remained on their initial combinations for a mean duration of ≈3 months. …