Budesonide/formoterol maintenance and reliever therapy versus fluticasone/salmeterol fixed-dose treatment in patients with COPD

Introduction: In asthma, maintenance and reliever therapy (MART) with inhaled corticosteroid (ICS)/formoterol reduces exacerbations compared to fixed-dose therapy with ICS/long-acting β2-agonist. No studies have investigated MART in patients with chronic obstructive pulmonary disease (COPD). Methods: COPD patients (smoking >10 pack years; post-bronchodilator FEV1 Results: 194 patients were randomised (MART n=103; fixed-dose n=91). No significant difference was seen between MART and fixed-dose therapy in number of exacerbations (58 vs 52, respectively, relative risk (RR) 0.98 [95% CI 0.77-1.26]; p=0.90) (table 1). Similar proportions of patients reported adverse events (MART: 73.1% vs fixed-dose: 67.1%, p=0.38), but more patients had pneumonia with MART vs fixed-dose therapy (8 [7.8%] vs 1 [1.1%], respectively, RR 7.07 [95% CI 0.90-55.44]; p=0.04). Conclusions: In COPD, budesonide/formoterol MART is equally effective as fluticasone/salmeterol fixed-dose therapy, but pneumonia was more common with budesonide/formoterol MART.