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Therapeutics/Prevention
Randomised controlled trial
LABA/LAMA combinations instead of LABA/ICS combinations may prevent or delay exacerbations of COPD in some patients
  1. Mario Cazzola,
  2. Paola Rogliani
  1. University of Rome Tor Vergata, Rome, Italy
  1. Correspondence to : Professor Mario Cazzola, Department of Systems Medicine, University Rome Tor Vergata, Via Montpellier 1, Rome 00133, Italy; mario.cazzola{at}uniroma2.it
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http://dx.doi.org/10.1136/ebmed-2016-110525

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    Commentary on: Wedzicha JA, Banerji D, Chapman KR, et al. Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD. N Engl J Med 2016;374:2222–34OpenUrlCrossRefPubMed.

    Context

    A substantial body of evidence shows that inhaled corticosteroids (ICSs) reduce the risk of exacerbations by 10–20% beyond that achieved by inhaled long-acting β2-adrenergic agonist (LABA) and also reduce progression of lung function loss, improving health-related quality of life.1 However, drawbacks of ICSs in chronic obstructive pulmonary disease (COPD) (increased risk of pneumonia, osteoporosis, hyperglycaemia in patients with diabetes, cataracts, skin bruising and glaucoma) are the reason why all COPD guidelines recommend ICSs only for patients with severe impairment and high risk of exacerbations.1 Nonetheless, ICSs are still overprescribed worldwide.2

    Methods

    A randomised, double-blind, double dummy, non-inferiority trial lasting 52 weeks enrolled 3362 patients suffering from COPD with …

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