Combination therapy with maintenance budesonide and formoterol in COPD

  1. A.R.L. Medford
  1. Dept of Respiratory Medicine, Southmead Hospital, Bristol, UK

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.

References

  1. Calverley PM, Boonsawat W, Cseke Z, Zhong N, Peterson S, Olsson H. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Respir J 2003;22:912–919.
  2. Calverley P, Pauwels R, Vestbo J, et al. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 2003;361:449–456.
  3. Barnes PJ. Scientific rationale for inhaled combination therapy with long-acting beta2-agonists and corticosteroids. Eur Respir J 2002;19:182–191.