The benefits of combined treatment with corticosteroids and long-acting beta agonists

Guidelines for the treatment of COPD recommend that long-acting beta agonists (LABA) are used initially to maximize lung function and relieve symptoms in patients with mild to moderate disease who are being treated with short-acting bronchodilators (www.goldcopd.com). Inhaled corticosteroid (ICS) therapy reduces exacerbation rates in patients with more severe disease (Burge et al 2000), and so guidelines recommend that these drugs are used for this purpose primarily in patients with FEV1 <50% predicted. ICS and LABA can be co-administered using combination inhalers, which give practical advantages as well as increasing compliance and maximizing the chance of synergistic interactions between the monocomponents. There is evidence that the combined LABA/ICS inhalers salmeterol/fluticasone propionate (Sal/FP) (Calverley et al 2003a) and formoterol/budesonide (F/Bud) (Calverley et al 2003b; Szafranski et al 2003) reduce exacerbation rates. Our current treatment strategies using LABA and ICS therefore have different goals (optimizing lung function, symptom relief, and exacerbation reduction), and are stratified by lung function.