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

MedStar author(s):
Citation: International Journal of Copd. 9:1163-86, 2014.PMID: 25378918Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleSubject headings: *Adrenal Cortex Hormones/ad [Administration & Dosage] | *Androstadienes/ad [Administration & Dosage] | *Beclomethasone/ad [Administration & Dosage] | *Lung/de [Drug Effects] | *Pulmonary Disease, Chronic Obstructive/dt [Drug Therapy] | Administration, Inhalation | Adrenal Cortex Hormones/ae [Adverse Effects] | Adrenal Cortex Hormones/ch [Chemistry] | Aged | Androstadienes/ae [Adverse Effects] | Androstadienes/ch [Chemistry] | Anti-Bacterial Agents/tu [Therapeutic Use] | Beclomethasone/ae [Adverse Effects] | Beclomethasone/ch [Chemistry] | Disease Progression | Emergency Service, Hospital | Female | Hospitalization | Humans | Lung/pp [Physiopathology] | Male | Middle Aged | Particle Size | Pulmonary Disease, Chronic Obstructive/di [Diagnosis] | Pulmonary Disease, Chronic Obstructive/pp [Physiopathology] | Retrospective Studies | Severity of Illness Index | Smoking Cessation | Smoking/ae [Adverse Effects] | Smoking/pc [Prevention & Control] | Time Factors | Treatment OutcomeYear: 2014ISSN:
  • 1176-9106
Name of journal: International journal of chronic obstructive pulmonary diseaseAbstract: 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.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 150318 and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection.PURPOSE: Small airway 150318s 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.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 150318) 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 mug/day versus 436 mug/day for initiation, 438 mug/day versus 534 mug/day for step-up patients).All authors: Burden A, Colice G, Gopalan G, Grigg J, Hillyer EV, Israel E, Martin RJ, Postma DS, Price D, Roche N, van Aalderen WM, von Ziegenweidt JFiscal year: FY2015Digital Object Identifier: Date added to catalog: 2015-03-18
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Journal Article MedStar Authors Catalog Article 25378918 Available 25378918

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.

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 150318 and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection.

PURPOSE: Small airway 150318s 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.

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 150318) 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 mug/day versus 436 mug/day for initiation, 438 mug/day versus 534 mug/day for step-up patients).

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