Comparing a fixed combination of budesonide/formoterol with other inhaled corticosteroid plus long-acting beta-agonist combinations in patients with chronic obstructive pulmonary disease: a review

Introduction: Inhaled corticosteroid (ICS) plus long-acting β2-agonist (LABA) combinations are commonly used in the treatment of patients with chronic obstructive pulmonary disease (COPD). At least four fixed-dose ICS/LABA combinations are available, including budesonide/formoterol, beclomethasone/formoterol, fluticasone/vilanterol and fluticasone/salmeterol, but there is little guidance for clinicians on which of these combinations to prescribe. Areas covered: The aim of this in-depth review was to identify studies that compared budesonide/formoterol with the other ICS/LABA combinations and assess the data on exacerbations, safety, and patient quality of life. PubMed and Ovid databases were searched, and 14 studies were identified. Our findings highlight the lack of prospective, randomized, controlled trials comparing LABA/ICS combinations in the treatment of COPD as only two such studies were identified. However, current evidence suggests that the effects of budesonide/formoterol on reducing exacerbations and improving quality of life may be similar to, or more marked than, those of other LABA/ICS combinations in COPD and, compared with the other LABA/ICS combinations, budesonide/formoterol may be associated with a lower incidence of serious pneumonia events and oral candidiasis. Expert opinion: To better guide clinicians in selecting between the available ICS/LABA, robust meta-analyses and well-designed head-to-head clinical trials are urgently needed.