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Which combination inhaler should we use for COPD?
3362 patients with at least one exacerbation of COPD in the previous year were randomised to a long acting β agonist Indacaterol (LABA) and a Long acting muscarinic agonist (LAMA) Glycopyrronium or LABA Salmeterol and inhaled glucocorticoid fluticasone (doi: 10.1056/NEJMoa1516385). The outcome was annual rate of COPD exacerbation. In the LABA-LAMA group there was an 11% reduction in the exacerbation rate (3.59 vs 4.03; rate ratio, 0.89; 95% CI, 0.83 to 0.96; p=0.003) with comparison to the LABA-steroid group. There was also a longer time to first exacerbation (71 days (95% CI 60 to 82) vs 51 days (95% CI 46 to 57); HR, 0.84 (95% CI 0.78 to 0.91), representing a 16% lower risk; p<0.001). The annual rate of severe exacerbations was lower (0.98 vs 1.19; rate ratio, 0.83; 95% CI 0.75 to 0.91; p<0.001). The exacerbation rate was independent of the blood eosinophil count. The incidence of pneumonia was 3.2% in the LABA-LAMA group and 4.8% in the LABA steroid group (p=0.02).
Dupilumab for asthma
Dupilumab is a fully human anti-interleukin-4 receptor α monoclonal antibody, which inhibits interleukin-4 and interleukin-13 signalling, these are drivers …
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Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.