There was no significant difference in mortality between people on combined inhalers and those on LABA, from 10 studies on 10,680 participants (OR 0.92 95% CI 0.76 to 1.11, downgraded to moderate quality evidence due to statistical imprecision). There was no significant difference in the rate of hospitalisations (rate ratio 0.79 95% CI 0.55 to 1.13, very low quality evidence due to risk of bias, statistical imprecision and inconsistency). Concerns over the effect of reporting biases led us to downgrade the quality of evidence for this effect from high to moderate. With a risk of an exacerbation of 47% in the LABA group over one year, 42% of people treated with LABA/ICS would be expected to experience an exacerbation. When analysed as the number of people experiencing one or more exacerbations over the course of the study, FPS lowered the odds of an exacerbation with an odds ratio (OR) of 0.83 (95% CI 0.70 to 0.98, 6 studies, 3357 participants). Our confidence in this effect was limited by statistical heterogeneity between the results of the studies (I 2 = 68%) and a risk of bias from the high withdrawal rates across the studies. This corresponds to one exacerbation per person per year on LABA and 0.76 exacerbations per person per year on ICS/LABA. Primary outcomes There was low quality evidence that exacerbation rates in people using LABA/ICS inhalers were lower in comparison to those with LABA alone, from nine studies which randomised 9921 participants (rate ratio 0.76 95% CI 0.68 to 0.84). The studies were well‐designed with low risk of bias for randomisation and blinding but they had high rates of attrition, which reduced our confidence in the results for outcomes other than mortality.
COMBINATION STEROID AND LAMA INHALER PLUS
We looked at any LABA plus ICS inhaler (LABA/ICS) versus the same LABA component alone, and then we looked at the 10 studies which assessed fluticasone plus salmeterol (FPS) and the four studies assessing budesonide plus formoterol (BDF) separately. Fourteen studies met the inclusion criteria, randomising 11,794 people with severe COPD.
0 kommentar(er)
