Shih-Lung Cheng, 1,2 Kang-Cheng Su, 3 Hao-Chien Wang, 4, * Diahn-Warng Perng, 3, * Pan-Chyr Yang 4
1 Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, 2 Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan County, 3 Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, 4 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
*These authors contributed equally to this work
Purpose: Complications of pneumonia development in patients with chronic obstructive pulmonary disease (COPD) receiving inhaled corticosteroid (ICS) therapy have been documented. The aim of this study was to focus on clinical efficacy and the incidence of pneumonia between COPD patients receiving medium and high doses of ICS.
Patients and methods: This prospective, randomized study included COPD patients identified from three tertiary medical centers from 2010 to 2012. The patients were randomized into two groups: high dose (HD; fluticasone 1,000 µg + salmeterol 100 µg/day) and medium dose (MD; fluticasone 500 µg + salmeterol 100 µg/day). Lung function with forced expiratory volume in 1 second (FEV 1 ), forced vital capacity, and COPD-assessment test (CAT) were checked every 2 months. The frequency of acute exacerbations and number of pneumonia events were measured. The duration of the study period was 1 year.
Results: In total, 237 COPD patients were randomized into the two treatment arms (115 in the HD group, 122 in the MD group). The FEV 1 level was significantly improved in the patients in the HD group compared with those in the MD group (HD ± mL versus MD ± mL, P <) at the end of the study. CAT scores were markedly improved in patients using an HD compared to those using an MD (HD 13±5 versus MD 16±7, P =). There was a significant difference in the percentage of annual rates in acute exacerbations (HD versus MD , P <) between the two groups. The incidence of pneumonia was similar in the two groups (HD versus MD , P =).
Conclusion: COPD patients treated with high doses of ICS had more treatment benefits and no significant increases in the incidence in pneumonia. Higher-dose ICS treatment may be suitable for COPD therapy.
Keywords: chronic obstructive pulmonary disease, pneumonia, inhaled corticosteroids
Fluticasone; vilanterol inhalation is not indicated for use in children. The safety and efficacy of the combination have not been established in infants, neonates, children, and adolescents. Available data from controlled clinical trials suggest that long-acting beta-agonists increase the risk of asthma-related hospitalization in pediatric and adolescent patients. Among subjects aged 12 to 17 years, asthma-related hospitalizations occurred in 4 subjects (%) treated with Breo Ellipta 100/25 (n = 151) compared with 0 subjects treated with fluticasone furoate 100 mcg (n = 130). There were no asthma-related deaths or asthma-related intubations observed in this trial. Growth inhibition has been observed in some children following therapy with high-dose fluticasone propionate inhalations (., Flovent). Children receiving fluticasone inhalations should be monitored closely for growth inhibition; the effect of fluticasone on final adult height is not known.