Long-term treatment of moderate and severe COPD with the fixed combination of budesonide/formoterol (Symbicort) was associated with fewer severe exacerbations, pneumonia, and pneumonia requiring mechanical ventilation than patients treated with fluticasone/salmeterol (Advair), according to a retrospective comparative study published in the International Journal of COPD.
Researchers in Taiwan identified adult 141,855 patients between 40 and 100 years old with COPD using ICD-9-CM codes 491, 492, and 496. Inclusion criteria included a record of at least three outpatient or one inpatient visits for COPD and ever undergone a lung function test within 1 year before and after the diagnosis of COPD had been established. Of those patients, 18,956 patients received a fixed ICS and LABA combination (11,519 patients receiving fluticasone/salmeterol and 7,437 receiving budesonide/formoterol).
According to the study, the major findings included;
- The fluticasone/salmeterol group had higher incidence rate and higher risk of pneumonia than patients in the budesonide/formoterol group.
- The F/S group had higher incidence rate and higher risk of pneumonia requiring mechanical ventilation
- The F/S group had higher incidence rate and higher risk of mortality than patients in the B/F group.
“Several factors may help to explain the differences in effectiveness between budesonide/formoterol and fluticasone/salmeterol,” the researchers wrote. “Studies have shown that budesonide/formoterol results in a more rapid onset of bronchodilation and offers faster symptom control than fluticasone/salmeterol. Better symptom control may contribute to the lower rate of emergency department visits or hospitalizations in the long term.”