Combining COPD Therapies Aids Older Adults with Comorbid Asthma

September 19, 2014
Jeannette Y. Wick, RPh, MBA, FASCP

Combining 2 classes of COPD medications leads to better outcomes for older adults with comorbid asthma.

Although chronic obstructive pulmonary disease (COPD) is manageable with medication, clinical researchers have been unable to determine whether a particular drug regimen is more effective than another. In addition, medications used to treat COPD have side effects that can affect drug adherence. Consequently, identifying prescription medications that improve health outcomes in COPD is a research imperative.

The Journal of the American Medical Association recently published a population-based, longitudinal cohort study comparing the long-term benefits of long-acting beta-agonists (LABAs) combined with inhaled corticosteroids (ICS) to those of LABAs alone in patients aged 66 years or older.

The 38,266 study participants were residents of Ontario, Canada, who had been diagnosed with COPD. The researchers followed the participants from 2003 to 2011, monitoring for new prescriptions for LABA/ICS combination therapy or LABAs alone. The study’s composite outcome was death and COPD-related hospitalization.

Among the participants, the researchers identified 5594 new users of LABA/ICS combination therapy, and 2129 new users of LABAs alone. According to the study authors, new use of LABAs and ICS was associated with a modestly reduced risk of mortality or COPD hospitalization, compared with new use of LABAs alone.

Unlike previous trials, this study allowed COPD patients with comorbid asthma to participate. This comorbidity is common, as most statistics report that up to one-third of COPD patients also have asthma. Ultimately, those with both COPD and asthma comprised 28% of the study’s matched cohort.

COPD patients without asthma are generally not considered to be responsive to corticosteroids. As a result, practice guidelines for COPD recommend LABAs alone as first-line treatment, while guidelines for asthma warn against the use of LABAs without ICS and often recommend long-acting anticholinergics (LAAs).

In this study, COPD patients who did not have asthma and received LABA/ICS combination therapy had lower risk for disease exacerbation and death compared to those with asthma who received LABAs and ICS. However, this finding did not extend to those without asthma who received LAAs, possibly because these participants had more severe disease that hindered their response to medications, the study authors suggested.

Thus, the researchers concluded that, for older adults with COPD—particularly those with asthma—LABA/ICS combination therapy leads to better patient outcomes than LABAs alone.