P5.2 Comparison of Inhaled Medications

A systematic review examined the relative effectiveness of inhaled medications to reduce the risk of exacerbations of COPD (Puhan et al 2009). The authors identified 35 randomised controlled trials of at least 4 weeks duration that enrolled 26,786 patients with COPD of whom 27% had one or more exacerbations. All regimes significantly reduced the odds of exacerbation compared with placebo - no single inhaled medication was more effective than another. If FEV₁ was ≤ 40% predicted, long acting anticholinergics, inhaled glucocorticoids and combination treatment reduced exacerbations significantly compared with long-acting beta agonists alone. However the authors did not have FEV₁ data for individual patients.