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

Int J Chron Obstruct Pulmon Dis. 2014 Oct 17;9:1163-86. doi: 10.2147/COPD.S68289. eCollection 2014.

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.

Keywords: COPD exacerbation; extrafine particle; matched cohort analysis; real life; small airways.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

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

Substances

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