title: Benefits of adding fluticasone propionate/salmeterol to tiotropium in COPD: a meta-analysis.
abstract: OBJECTIVE
  This meta-analysis was performed to evaluate the efficacy and safety of adding fluticasone propionate/salmeterol (FSC) to tiotropium (Tio) in COPD patients.
  
  
  METHODS
  A systematic search was made of MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases, and a hand search of leading respiratory journals. Randomized clinical trials on treatment of stable COPD with the addition of FSC, compared with tiotropium alone, were reviewed. Studies were pooled to odds ratio (OR) and weighted mean differences (WMD), with 95% confidence interval (CI).
  
  
  RESULTS
  Six trials met the inclusion criteria. Compared with tiotropium, addition of FSC presented significant effects on trough forced expiratory volume in 1s (FEV1) (WMD 54.64 mL; 95% CI 51.76 to 57.52 mL; P<0.001), COPD exacerbations (OR 0.73; 95% CI 0.55 to 0.96; p=0.03), and health-related quality of life (WMD 4.63; 95% CI 4.26 to 5.01; P<0.001). No significant increase was noticed in adverse events in the Tio+FSC group (OR 1.24; 95% CI 0.98 to 1.57; p=0.07).
  
  
  CONCLUSIONS
  The addition of FSC to subjects with COPD treated with tiotropium significantly improves lung function, quality of life and COPD exacerbations without increasing the risk of adverse events.
authors.affiliation: Department of Respiratory Medicine, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China. Electronic address: xian_liuyun@163.com.
authors.forename: Yun
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Respiratory Medicine, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Hongyang
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Respiratory Medicine, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Xiuzhen
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Respiratory Medicine, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Dexin
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Respiratory Medicine, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Yuping
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Xi'an North Hospital, Xi'an, Shaanxi Province, China.
authors.forename: Kunzheng
authors.initials: K
authors.lastname: Yang
authors.affiliation: Department of Respiratory Medicine, Traditional Chinese Medical Hospital of Shaanxi Province, Xi'an, Shaanxi Province, China.
authors.forename: Liehan
authors.initials: L
authors.lastname: Mi
authors.affiliation: Department of Respiratory Medicine, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Manxiang
authors.initials: M
authors.lastname: Li
mesh_terms: D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000730:Androstadienes / Q000008:administration & dosage* / Q000627:therapeutic use*; D018450:Disease Progression; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D000068297:Fluticasone-Salmeterol Drug Combination; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D012129:Respiratory Function Tests; D012602:Scopolamine Derivatives / Q000008:administration & dosage*; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D000730:Androstadienes; D004338:Drug Combinations; D000068297:Fluticasone-Salmeterol Drug Combination; D012602:Scopolamine Derivatives; D000420:Albuterol; D000069447:Tiotropium Bromide
keywords: COPD; Efficacy; Fluticasone propionate/salmeterol; Meta-analysis; Safety; Tiotropium