chronic obstructive pulmonary disease, stable
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2018 Apr 18. doi: 10.1056/NEJMoa1713901. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
triple inhaled therapy (glucocorticoid - fluticasone, long-acting muscarinic antagonist (LAMA) - umeclidinium, and a long-acting β2-agonist (LABA) - vilanterol)
As Treatment, Chronic
Is better Than
any dual therapy combination
To reduce the annual rate of moderate or severe exacerbations: 0.9 triple tt VS. 1.1 dual tt. Higher risk of pneumonia in dual or triple Tt taking glucocorticoids.
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003566 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, stable The Use of
cardioselective beta-blockers
As Treatment, Chronic
Is equal Than
placebo
To modify respiratory function: no significant difference, at 3 months, in FEV1 or respiratory symptoms
BMJ. 2011 May 10;342:d2549. doi: 10.1136/bmj.d2549 Cohorts
IN chronic obstructive pulmonary disease, stable The Use of
cardioselective beta-blockers, given in addition to inhaled corticosteroid and long acting β agonist, with or without long acting antimuscarinic
As Treatment, Chronic
Is better Than
no beta-blockers use
To reduce all-cause mortality (22% relative reduction) and reduce hospital admissions due to respiratory disease.
N Engl J Med. 2000 Dec 28;343(26):1902-1909 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is equal Than
placebo
To reduce the rate of decline of post-bronchodilator FEV1 at 3 years. It reduced the visits to a physician because of a respiratory illness (1.2% /year in intv. VS 2.1% /year in ctrl.) and reduced symptoms.
Chest. 2007 Mar;131(3):682-9 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To increase, at 6 months, FEV1 (mean of 42 mL in men and 29 mL in women compared with placebo) and keep this difference afterwards
Cochrane Database Syst Rev. 2007;(2):CD002991 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To temporarily (first 6 months) reduce the decline of FEV1 and reduce at long term rate of exacerbations (-0.26 /patient/year)
Lancet. 1998 Mar 14;351(9105):773-80 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To reduce excerbation rate at 6 months (32% in intv. VS 37% in ctrl.) and increase FEV1, symptoms and 6 min walking distance
Lancet. 1999 May 29;353(9167):1819-23 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is equal Than
placebo
To reduce the rate of decline in FEV1, reduce exacerbations or improve symptoms at 3 years.
BMJ. 2000 13 May;320(7245):1297-1303 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To reduce excerbation rate (0,99/year in intv. VS 1,32/year in ctrl.) and produce a small increase in FEV1. But it did not affect the rate of decline in FEV1
N Engl J Med. 1999 Jun 24;340(25):1948-53 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To reduce the rate of decline of post-bronchodilator FEV1 in the first 6 monts of treatment but but does not appreciably affect the long-term progressive decline.
Thorax. 2003 Nov;58(11):937-41 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To reduce the rate of FEV1 decline (mean reduction 7.7 ml/year, and with high dose regimens 9.9 ml/year)
JAMA. 2008 Nov 26;300(20):2407-16 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is equal Than
placebo
To reduce overall mortality at 1 year (RR 0.86). Inhaled corticoids increased pneumonia rate (RR 1.34).
Chest. 2010 Feb;137(2):318-25 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To modestly reduce exacerbations rate (RR 0.82) across all levels of severity.
Am J Respir Crit Care Med. 2009 Oct 15;180(8):741-50 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled (budesonide), combined with inhaled long-acting beta2 agonists (formoterol), added to inhaled long-acting anticholinergics (tiotropium)
As Treatment, Chronic
Is better Than
placebo plus tiotropium
To improve, at 3 months, VEMS (1.14 cortics/beta2 VS 1.08 placebo), improve respiratory symptoms and reduce exacerbations (8% cortics/beta2 VS 18% placebo)
N Engl J Med. 2007 Feb 22;356(8):775-89 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled (fluticasone), alone or combined with inhaled long-acting beta2 agonists
As Treatment, Chronic
Is equal Than
placebo
To modify survival 3 years. There was a trend to better survival with combined inhaled corticosteroids plus lon-acting beta2 agonists but it did not reach sisnificance
J Gen Intern Med. 2006 Oct;21(10):1011-9 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
inhaled anticholinergics
As Treatment, Chronic
Is better Than
long acting beta2-agonists
To reduced severe exacerbations (RR 0.67, compared to placebo) and respiratory deaths (RR 0.27, compared to placebo) while beta2-agonists associated increased risk for respiratory deaths
Cochrane Database Syst Rev. 2006 Jul 19;3:CD006101 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, stable The Use of
inhaled anticholinergics, ipratropium bromide
As Treatment, Chronic
Is equal Than
long acting beta2-agonists
To to improve COPD symptoms and exercise tolerance, although beta2-agonists improved better morning PEF and FEV1. combination therapy was a little better than beta-2 agonists alone for symptoms.
Thorax. 2006 Oct;61(10):854-62. Epub 2006 Jul 14 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
inhaled anticholinergics, long acting, tiotropium
As Treatment, Chronic
Is better Than
placebo, ipratropium bromide, or long acting beta2-agonists
To reduce exacerbations (OR 0.73) and related hospitalisation (OR 0.68), but not to reduce mortality, all-cause or specific
Ann Intern Med. 2007 Nov 6;147(9):639-53 Systematic Review
IN chronic obstructive pulmonary disease, stable The Use of
long-acting beta2 agonists plus corticosteroids, inhaled and oxygen ; pulmonary rehabilitation
As Treatment, Chronic
Is better Than
placebo or inhaled corticosteroids alone and no oxygen
To reduce mortality (8.6% long-acting beta2 plus cortics VS 11% controls) (oxygen in resting hypoxemic patients RR 0.61). All lon-acting bronchodilators (B2 or tiatropium) reduced exacerbations and rehabilitation improved health status.
Lancet. 2008 Jun 14;371(9629):2013-8 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
mucolytics, carbocisteine
As Treatment, Chronic
Is better Than
placebo
To reduce exacerbation rate: 1.01 per patient per year with carbocisteine VS 1.35 placebo.
Lancet. 2005 Apr 30;365(9470):1552-60 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
mucolytics, N-acetylcysteine
As Treatment, Chronic
Is equal Than
placebo
To reduce yearly reduction in pulmonary function (FEV1 reduction 54ml VS 47ml/y) and the number of exacerbations per year (1.5 VS 1.29)
Chest. 2001 Jun;119(6):1661-70 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable The Use of
theophylline, added to inhaled beta2-agonists
As Treatment, Chronic
Is better Than
inhaled beta2-agonists alone
To reduce - at 3 months - symptoms and dyspnea (53% in Theo+B2 VS 40% in B2 alone) and improve FEV1. Number of exacerbations was not significantly different and theophylline increased adverse effects.
N Engl J Med. 2017 Sep 07;377(10):923-935 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable, early stage The Use of
inhaled anticholinergics, long acting, tiotropium
As Treatment, Chronic
Is better Than
placebo
To slightly improve at 2 years the FEV1 (mean difference 71 to 133 ml after bronchodilator use) and slightly reduce the decline of FEV1 after bronchodilator use (29 ml/year tiotrop VS 51 ml/year placebo)
N Engl J Med. 2011 Mar 24;364(12):1093-103 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable, moderate to severe The Use of
inhaled anticholinergics, long acting, tiotropium
As Treatment, Chronic
Is better Than
long acting beta2-agonists, salmeterol
To reduce number of moderate or seve exarcerbations at 1 year: 0.64 tiotropium VS 0.72 salmeterol. the incidence of serious adverse events was similar.