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Intensified therapy with inhaled corticosteroids and long-acting ß2-agonists at the onset of upper respiratory tract infection to prevent chronic obstructive pulmonary disease exacerbations. A multicenter, randomized, double-blind, placebo-controlled trial

Daiana Stolz, Hans H Hirsch, Daniel Schilter, et al.
Am J Resp Crit Care Med 2018;197:1136–46

Upper respiratory tract infections (URTI) are strongly associated with chronic obstructive pulmonary disease (COPD) exacerbations, resulting in hospital admissions and increasing the risk of mortality. Use of intensified combination therapy, involving inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABA), at the onset of URTI symptoms may help reduce their effect in COPD patients. In this study, researchers explored the efficacy of ICS/LABA therapy at the onset of URTI symptoms in COPD patients by measuring the occurrence of COPD exacerbations. They conducted a multicentre, randomised, double-blind, placebo-controlled trial in which 450 patients with stable, moderate to very severe COPD were tested.

Participants were randomised into two conditions in which they were provided either an intensified dose of ICS/LABA or a placebo. They were instructed to take the medication twice daily for 10 days at the onset of URTI symptoms. Findings showed that intensified ICS/LABA therapy did not significantly decrease the incidence of COPD exacerbations when compared with placebo therapy (14.6% vs. 16.2%, respectively). However, the risk of severe exacerbation decreased by 72% in the ICS/LABA group. Researchers therefore concluded that use of intensified combination therapy with ICS/LABA at the onset of URTI symptoms does not decrease the incidence of COPD exacerbations. However, it may help manage the severity of exacerbation experienced.

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