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A recent study published in The BMJ has found that budesonide-glycopyrrolate-formoterol, a twice-daily metered dose inhaler, offers no significant clinical advantage over fluticasone-umeclidinium-vilanterol, a once-daily dry powder inhaler, in the management of chronic obstructive pulmonary disease (COPD). The study also indicated that patients using budesonide had a higher risk of moderate and severe exacerbations.
Study Findings
Researchers conducted a propensity score-matched cohort study with 20,388 matched pairs of new users to compare the effectiveness of the two inhaler therapies. The analysis revealed that patients using budesonide-glycopyrrolate-formoterol had a higher incidence of first moderate or severe COPD exacerbations compared to those using fluticasone-umeclidinium-vilanterol. The study reported a hazard ratio of 1.09 (95% CI: 1.04–1.14), with a number needed to harm (NNH) of 38.
Further findings showed that while the risk of hospital admission for pneumonia was similar between both groups (hazard ratio: 1.00; 95% CI: 0.19–1.10), budesonide-glycopyrrolate-formoterol users had an elevated risk for first moderate exacerbations (hazard ratio: 1.07; 95% CI: 1.02–1.12) and severe COPD exacerbations (hazard ratio: 1.29; 95% CI: 1.12–1.48).
Clinical Implications
These findings raise important considerations for clinicians when selecting an appropriate inhaler therapy for COPD patients. The increased risk of exacerbations associated with budesonide-glycopyrrolate-formoterol suggests that fluticasone-umeclidinium-vilanterol may be a preferable option for some patients. However, individual patient needs and responses to treatment should guide therapy decisions.
Conclusion
The study provides new insights into COPD management, emphasizing the need for careful selection of inhaler therapies to minimize exacerbation risks. Clinicians are encouraged to evaluate these findings in the context of their patients’ health profiles before making treatment decisions.
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice. Patients should consult their healthcare providers before making any changes to their treatment plans.
(Source: https://medicalxpress.com/news/2025-01-inhaler-triple-therapies-treatment-copd.html)
