Which medications work best for older adults with chronic obstructive pulmonary disease?

Doctors aren’t entirely sure: Despite the fact that COPD is the third-leading cause of death, there is scant research on the comparative effectiveness of treatment options in seniors. But a study recently published in The Journal of the American Medical Association provides valuable new information.

For their new study, researchers in Ontario combed through records of all adults ages 66 and older with COPD who had started taking two types of medications: long-acting beta agonists and inhaled corticosteroids.

Clinical guidelines recommend that doctors begin treatment for COPD with long-acting beta agonists (or another set of medications called long-acting anticholinergics, not studied in this report), then add other medications if necessary. But it has never been clear if this is optimal for older adults.

The Canadian study is the first to focus on seniors in real-world settings who tend to have lots of complications, unlike people included in gold-standard clinical trials, which tend to exclude patients with multiple medical conditions.

The researchers examined administrative health records for 2,129 older adults taking long-acting beta agonists alone and 5,594 adults taking them with corticosteroids, documenting how many in each group were hospitalized and died over a period of about two and a half years.

They found that seniors taking both medications had 8 percent fewer deaths and hospitalizations during this period, compared with those taking long-acting beta agonists alone, a result they called modest but significant.