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1 Worldwide Epidemiology and 2 Statistics and Programming Depts, GlaxoSmithKline Research and Development, Greenford, and 3 Clinical Respiratory Dept, GlaxoSmithKline Research and Development, Stockley Park, UK. 4 Respiratory and Environmental Health Research Unit, Municipal Institute of Medical Research, Barcelona, Spain. 5 Dept of Respiratory Medicine, Hvidovre University Hospital, Copenhagen, Denmark. 6 Thoracic Medicine, National Heart and Lung Institute, Imperial College School of Medicine, London, UK
CORRESPONDENCE: J.B. Soriano, Worldwide Epidemiology, GlaxoSmithKline R&D, Greenford Road, Greenford, Middlesex, UB6 0HE, UK. Fax: 44 20 89662475. E-mail: joan.b.soriano@gsk.com
Keywords: chronic obstructive pulmonary disease, epidemiology, fluticasone propionate, General Practice Research Database, salmeterol, survival
Received: December 5, 2001
Accepted May 7, 2002
Despite substantial evidence regarding the benefits of combined use of inhaled corticosteroids and long-acting ß2-agonists in asthma, such evidence remains limited for chronic obstructive pulmonary disease (COPD). Observational data may provide an insight into the expected survival in clinical trials of fluticasone propionate (FP) and salmeterol in COPD.
Newly physician-diagnosed COPD patients identified in primary care during 1990–1999 aged
Survival at year 3 was significantly greater in FP and/or salmeterol users (78.6%) than in the reference group (63.6%). After adjusting for confounders, the survival advantage observed was highest in combined users of FP and salmeterol (hazard ratio (HR) 0.48 (95% confidence interval 0.31–0.73)), followed by users of FP alone (HR 0.62 (0.45–0.85)) and regular users of salmeterol alone (HR 0.79 (0.58–1.07)) versus the reference group. Mortality decreased with increasing number of prescriptions of FP and/or salmeterol.
In conclusion, regular use of fluticasone propionate alone or in combination with salmeterol is associated with increased survival of chronic obstructive pulmonary disease patients managed in primary care.
50 yrs, of both sexes and with regular prescriptions of respiratory drugs were identified in the UK General Practice Research Database. Three-year survival in 1,045 COPD patients treated with FP and salmeterol was compared with that in 3,620 COPD patients who regularly used other bronchodilators but not inhaled corticosteroids or long-acting ß2-agonists. Standard methods of survival analysis were used, including adjustment for possible confounders.
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