BACKGROUND: Long-acting bronchodilators comprising long-acting beta(2)-agonists and the anticholinergic agent tiotropium are commonly used, either on their own or in combination, for managing persistent symptoms of chronic obstructive pulmonary disease. Patients with severe chronic obstructive pulmonary disease who are symptomatic and who suffer repeated exacerbations are recommended to add inhaled corticosteroids to their bronchodilator treatment. However, the benefits and risks of adding inhaled corticosteroid to tiotropium and long-acting beta(2)-agonists for the treatment of chronic obstructive pulmonary disease are unclear. OBJECTIVES: To assess the relative effects of adding inhaled corticosteroids to tiotropium and long-acting beta(2)-agonists treatment in patients with chronic obstructive pulmonary disease. SEARCH STRATEGY: We searched the Cochrane Airways Group Specialised Register of trials (February 2011) and reference lists of articles. SELECTION CRITERIA: We included parallel group, randomised controlled trials of three months or longer comparing inhaled corticosteroid and long-acting beta(2)-agonist combination therapy in addition to inhaled tiotropium against tiotropium and long-acting beta(2)-agonist treatment for patients with chronic obstructive pulmonary disease (COPD). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and then extracted data on trial quality and the outcome results. We contacted study authors for additional information. We collected information on adverse effects from the trials. MAIN RESULTS: One trial (293 patients) was identified comparing tiotropium in addition to inhaled corticosteroid and long-acting beta(2)-agonist combination therapy to tiotropium plus long-acting beta(2)-agonist. The study was of good methodological quality, however it suffered from high and uneven withdrawal rates between the treatment arms. There is currently insufficient evidence to know how much difference the addition of inhaled corticosteroids makes to people who are taking tiotropium and a long-acting beta(2)-agonist for COPD. AUTHORS' CONCLUSIONS: The relative efficacy and safety of adding inhaled corticosteroid to tiotropium and a long-acting beta(2)-agonist for chronic obstructive pulmonary disease patients remains uncertain and additional trials are required to answer this question.
BACKGROUND: Long-acting bronchodilators comprising long-acting beta(2)-agonists and the anticholinergic agent tiotropium are commonly used, either on their own or in combination, for managing persistent symptoms of chronic obstructive pulmonary disease. Patients with severe chronic obstructive pulmonary disease who are symptomatic and who suffer repeated exacerbations are recommended to add inhaled corticosteroids to their bronchodilator treatment. However, the benefits and risks of adding inhaled corticosteroid to tiotropium and long-acting beta(2)-agonists for the treatment of chronic obstructive pulmonary disease are unclear. OBJECTIVES: To assess the relative effects of adding inhaled corticosteroids to tiotropium and long-acting beta(2)-agonists treatment in patients with chronic obstructive pulmonary disease. SEARCH STRATEGY: We searched the Cochrane Airways Group Specialised Register of trials (February 2011) and reference lists of articles. SELECTION CRITERIA: We included parallel group, randomised controlled trials of three months or longer comparing inhaled corticosteroid and long-acting beta(2)-agonist combination therapy in addition to inhaled tiotropium against tiotropium and long-acting beta(2)-agonist treatment for patients with chronic obstructive pulmonary disease (COPD). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and then extracted data on trial quality and the outcome results. We contacted study authors for additional information. We collected information on adverse effects from the trials. MAIN RESULTS: One trial (293 patients) was identified comparing tiotropium in addition to inhaled corticosteroid and long-acting beta(2)-agonist combination therapy to tiotropium plus long-acting beta(2)-agonist. The study was of good methodological quality, however it suffered from high and uneven withdrawal rates between the treatment arms. There is currently insufficient evidence to know how much difference the addition of inhaled corticosteroids makes to people who are taking tiotropium and a long-acting beta(2)-agonist for COPD. AUTHORS' CONCLUSIONS: The relative efficacy and safety of adding inhaled corticosteroid to tiotropium and a long-acting beta(2)-agonist for chronic obstructive pulmonary diseasepatients remains uncertain and additional trials are required to answer this question.
Authors: T Effing; E M Monninkhof; P D L P M van der Valk; J van der Palen; C L A van Herwaarden; M R Partidge; E H Walters; G A Zielhuis Journal: Cochrane Database Syst Rev Date: 2007-10-17
Authors: Shawn D Aaron; Katherine L Vandemheen; Dean Fergusson; François Maltais; Jean Bourbeau; Roger Goldstein; Meyer Balter; Denis O'Donnell; Andrew McIvor; Sat Sharma; Graham Bishop; John Anthony; Robert Cowie; Stephen Field; Andrew Hirsch; Paul Hernandez; Robert Rivington; Jeremy Road; Victor Hoffstein; Richard Hodder; Darcy Marciniuk; David McCormack; George Fox; Gerard Cox; Henry B Prins; Gordon Ford; Dominique Bleskie; Steve Doucette; Irvin Mayers; Kenneth Chapman; Noe Zamel; Mark FitzGerald Journal: Ann Intern Med Date: 2007-02-19 Impact factor: 25.391
Authors: Peter M A Calverley; Julie A Anderson; Bartolome Celli; Gary T Ferguson; Christine Jenkins; Paul W Jones; Julie C Yates; Jørgen Vestbo Journal: N Engl J Med Date: 2007-02-22 Impact factor: 91.245
Authors: Guy Brusselle; David Price; Kevin Gruffydd-Jones; Marc Miravitlles; Dorothy L Keininger; Rebecca Stewart; Michael Baldwin; Rupert C Jones Journal: Int J Chron Obstruct Pulmon Dis Date: 2015-10-15
Authors: Annette J Theron; Helen C Steel; Gregory R Tintinger; Charles Feldman; Ronald Anderson Journal: Drug Des Devel Ther Date: 2013-11-22 Impact factor: 4.162