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Rodrigo and colleagues' systematic review of research examines an important, unresolved question relating to a common and disabling condition, chronic obstructive pulmonary disease (COPD). The trials included in the review used clinically important outcomes, unlike those evaluated a decade ago.
Perhaps because, like asthma, for which inhaled corticosteroids (ICSs) are considered almost essential, COPD is a disease of the airways, ICSs have achieved strong market penetration for COPD despite weak evidence of their efficacy or safety. A recent large, 3-year randomised controlled trial (RCT) comparing an ICS with a long-acting β-agonist (LABA) and the ICS/LABA combination showed benefit in secondary outcomes for the combination (though not in mortality, the primary outcome for which the trial was powered).1 This has reignited interest in ICS/LABA combinations for COPD, although the results of previous systematic reviews have been equivocal and a recent report found an increased risk of pneumonia in people with COPD …
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