Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD.

Abstract

PURPOSE:

Small airway changes and dysfunction contribute importantly to airway obstruction in chronic obstructive pulmonary disease (COPD), which is currently treated with inhaled corticosteroids (ICS) and long-acting bronchodilators at Global initiative for Obstructive Lung Disease (GOLD) grades 2-4. This retrospective matched cohort analysis compared effectiveness of a representative small-particle ICS (extrafine beclomethasone) and larger-particle ICS (fluticasone) in primary care patients with COPD.

PATIENTS AND METHODS:

Smokers and ex-smokers with COPD ≥ 40 years old initiating or stepping-up their dose of extrafine beclomethasone or fluticasone were matched 1:1 for demographic characteristics, index prescription year, concomitant therapies, and disease severity during 1 baseline year. During 2 subsequent years, we evaluated treatment change and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection.

RESULTS:

Mean patient age was 67 years, 57%-60% being male. For both initiation (n=334:334) and step-up (n=189:189) patients, exacerbation rates were comparable between extrafine beclomethasone and fluticasone cohorts during the 2 year outcome period. Odds of treatment stability (no exacerbation or treatment change) were significantly greater for patients initiating extrafine beclomethasone compared with fluticasone (adjusted odds ratio 2.50; 95% confidence interval, 1.32-4.73). Median ICS dose exposure during 2 outcome years was significantly lower (P<0.001) for extrafine beclomethasone than fluticasone cohorts (315 μg/day versus 436 μg/day for initiation, 438 μg/day versus 534 μg/day for step-up patients).

CONCLUSION:

We observed that small-particle ICS at significantly lower doses had comparable effects on exacerbation rates as larger-particle ICS at higher doses, whereas initiation of small-particle ICS was associated with better odds of treatment stability during 2-years' follow-up.

• Authors: Dirkje S Postma, Nicolas Roche, Gene Colice, Elliot Israel, Richard J Martin, Willem Mc van Aalderen, Jonathan Grigg, Anne Burden, Elizabeth V Hillyer, Julie von Ziegenweidt, Gokul Gopalan, David Price
• Journal: International journal of chronic obstructive pulmonary disease (Int J Chron Obstruct Pulmon Dis) Vol. 9 Pg. 1163-86 ( 2014) ISSN: 1178-2005 [Electronic] New Zealand
• PMID: 25378918 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Androstadienes
• Anti-Bacterial Agents
• Fluticasone
• Beclomethasone

Topics

• Administration, Inhalation
• Adrenal Cortex Hormones (administration & dosage, adverse effects, chemistry)
• Aged
• Androstadienes (administration & dosage, adverse effects, chemistry)
• Anti-Bacterial Agents (therapeutic use)
• Beclomethasone (administration & dosage, adverse effects, chemistry)
• Disease Progression
• Emergency Service, Hospital
• Female
• Fluticasone
• Hospitalization
• Humans
• Lung (drug effects, physiopathology)
• Male
• Middle Aged
• Particle Size
• Pulmonary Disease, Chronic Obstructive (diagnosis, drug therapy, physiopathology)
• Retrospective Studies
• Severity of Illness Index
• Smoking (adverse effects)
• Smoking Cessation
• Smoking Prevention
• Time Factors
• Treatment Outcome