title: Survival in COPD patients after regular use of fluticasone propionate and salmeterol in general practice.
abstract: Despite substantial evidence regarding the benefits of combined use of inhaled corticosteroids and long-acting beta2-agonists in asthma, such evidence remains limited for chronic obstructive pulmonary disease (COPD). Observational data may provide an insight into the expected survival in clinical trials of fluticasone propionate (FP) and salmeterol in COPD. Newly physician-diagnosed COPD patients identified in primary care during 1990-1999 aged > or = 50 yrs, of both sexes and with regular prescriptions of respiratory drugs were identified in the UK General Practice Research Database. Three-year survival in 1,045 COPD patients treated with FP and salmeterol was compared with that in 3,620 COPD patients who regularly used other bronchodilators but not inhaled corticosteroids or long-acting beta2-agonists. Standard methods of survival analysis were used, including adjustment for possible confounders. Survival at year 3 was significantly greater in FP and/or salmeterol users (78.6%) than in the reference group (63.6%). After adjusting for confounders, the survival advantage observed was highest in combined users of FP and salmeterol (hazard ratio (HR) 0.48 (95% confidence interval 0.31-0.73)), followed by users of FP alone (HR 0.62 (0.45-0.85)) and regular users of salmeterol alone (HR 0.79 (0.58-1.07)) versus the reference group. Mortality decreased with increasing number of prescriptions of FP and/or salmeterol. In conclusion, regular use of fluticasone propionate alone or in combination with salmeterol is associated with increased survival of chronic obstructive pulmonary disease patients managed in primary care.
authors.affiliation: Worldwide Epidemiology Dept, GlaxoSmithKline Research and Development, Greenford, Middlesex, UK. joan.b.soriano@gsk.com
authors.forename: J B
authors.initials: JB
authors.lastname: Soriano
authors.forename: J
authors.initials: J
authors.lastname: Vestbo
authors.forename: N B
authors.initials: NB
authors.lastname: Pride
authors.forename: V
authors.initials: V
authors.lastname: Kiri
authors.forename: C
authors.initials: C
authors.lastname: Maden
authors.forename: W C
authors.initials: WC
authors.lastname: Maier
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D000730:Androstadienes / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005194:Family Practice / Q000379:methods; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D012016:Reference Values; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D000068299:Salmeterol Xinafoate; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol