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Systematic review
Combination therapy with long-acting β-agonists plus inhaled corticosteroids is no more effective than LABA monotherapy for mortality outcomes and severe exacerbations in moderate to very severe COPD and is associated with serious adverse effects
  1. Peter Anthony Frith
  1. Correspondence to Peter Anthony Frith
    Professor in Respiratory Medicine, Flinders University of South Australia, Bedford Park 5042, Respiratory Allergy and Sleep Services, Repatriation General Hospital, Daw Park 5041, Australia; peter.frith{at}

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Commentary on:

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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  • Competing interests PAF has received funds for undertaking multi-centre clinical trials, speaker fees, consulting fees, reimbursements for attending symposia and support for organising education from Altana Pharma, AstraZeneca, Bayer, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Nycomed and Pfizer.