Combination therapy with maintenance budesonide and formoterol in COPD
To the Editors:
Calverley et al. 1 provide further evidence for combination therapy with inhaled corticosteroids and long-acting β-agonists in severe chronic obstructive pulmonary disease (COPD) as maintenance therapy. In addition, a previous study, also confirming such benefit, showed an advantage for monotherapy with fluticasone in reducing exacerbations 2. The study by Calverley et al. 1 did not show a benefit for budesonide monotherapy in exacerbation reductions. Does monotherapy with inhaled steroids reduce exacerbations in severe COPD?
The conclusion that “additional clinical benefit when combined in a single inhaler” would surely be further strengthened by assessing the effectiveness of the fixed-dose single inhaler combination against the same drugs in separate inhalers? As there are sound cellular reasons for combining these two classes of drug 3, would there not be a potential advantage in the use of these two drugs as separate inhalers to allow greater dose flexibility, although this is of greater relevance in asthma? Or, if fixed-dose combinations are superior to separate inhalers taken together, then would this also be an important finding to favour the former?
- Received July 6, 2004.
- Accepted July 14, 2004.
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