title: The impact of LABA+ICS fixed combinations on morbidity and economic burden of COPD in Italy: a six-year observational study.
abstract: BACKGROUND
  In Italy, chronic obstructive pulmonary disease (COPD) has progressively received increasing attention in the last decade, and its impact has been investigated extensively in both clinical and pharmacoeconomic terms.
  
  
  METHODS
  In 2004, the national health authorities stated the appropriateness of long-acting β(2) agonists (LABA) and inhaled corticosteroids (ICS) fixed combinations for treating COPD, even though this pharmaceutical option was limited to the severe and very severe stages of the disease (forced expiratory volume in one second [FEV(1)] <50% predicted). The effectiveness in primary care of this official recommendation has been investigated in 1125 COPD patients together with the appropriateness of the therapeutic approach to the disease.
  
  
  RESULTS
  and conclusions: Clinical and economic outcomes were monitored over the 3 years before (2001-2003) and the 3 years following this recommendation (2004-2006), and statistically compared (t-test). In general, the overall impact of COPD changed progressively after the pronunciation of the public health authorities. In particular, since the point when LABA/ICS fixed combinations were officially recommended, both morbidity of COPD and the corresponding consumption of healthcare resources have progressively lowered. Moreover, the appropriateness of the pharmaceutical approach increased in the same period, thus emphasizing the importance of the optimization of therapeutic strategies in reducing the long-term impact of the disease.
authors.affiliation: Lung Department, Orlandi General Hospital, via Ospedale 2, Bussolengo 37012, Verona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Dal Negro
authors.forename: Luca
authors.initials: L
authors.lastname: Bonadiman
authors.forename: Silvia
authors.initials: S
authors.lastname: Tognella
authors.forename: Claudio
authors.initials: C
authors.lastname: Micheletto
authors.forename: Paola
authors.initials: P
authors.lastname: Turco
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000191:economics*; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000191:economics*; D000368:Aged; D004359:Drug Therapy, Combination; D017850:Economics, Pharmaceutical / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists