title: Combination long-acting β-agonists and inhaled corticosteroids compared with long-acting β-agonists alone in older adults with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease (COPD), a manageable respiratory condition, is the third leading cause of death worldwide. Knowing which prescription medications are the most effective in improving health outcomes for people with COPD is essential to maximizing health outcomes.
  
  
  OBJECTIVE
  To estimate the long-term benefits of combination long-acting β-agonists (LABAs) and inhaled corticosteroids compared with LABAs alone in a real-world setting.
  
  
  METHODS
  Population-based, longitudinal cohort study conducted in Ontario, Canada, from 2003 to 2011. All individuals aged 66 years or older who met a validated case definition of COPD on the basis of health administrative data were included. After propensity score matching, there were 8712 new users of LABA-inhaled corticosteroid combination therapy and 3160 new users of LABAs alone who were followed up for median times of 2.7 years and 2.5 years, respectively.
  
  
  METHODS
  Newly prescribed combination LABAs and inhaled corticosteroids or LABAs alone.
  
  
  METHODS
  Composite outcome of death and COPD hospitalization.
  
  
  RESULTS
  The main outcome was observed among 5594 new users of LABAs and inhaled corticosteroids (3174 deaths [36.4%]; 2420 COPD hospitalizations [27.8%]) and 2129 new users of LABAs alone (1179 deaths [37.3%]; 950 COPD hospitalizations [30.1%]). New use of LABAs and inhaled corticosteroids was associated with a modestly reduced risk of death or COPD hospitalization compared with new use of LABAs alone (difference in composite outcome at 5 years, -3.7%; 95% CI, -5.7% to -1.7%; hazard ratio [HR], 0.92; 95% CI, 0.88-0.96). The greatest difference was among COPD patients with a codiagnosis of asthma (difference in composite at 5 years, -6.5%; 95% CI, -10.3% to -2.7%; HR, 0.84; 95% CI, 0.77-0.91) and those who were not receiving inhaled long-acting anticholinergic medication (difference in composite at 5 years, -8.4%; 95% CI, -11.9% to -4.9%; HR, 0.79; 95% CI, 0.73-0.86).
  
  
  CONCLUSIONS
  Among older adults with COPD, particularly those with asthma and those not receiving a long-acting anticholinergic medication, newly prescribed LABA and inhaled corticosteroid combination therapy, compared with newly prescribed LABAs alone, was associated with a significantly lower risk of the composite outcome of death or COPD hospitalization.
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Department of Medicine, University of Toronto, Toronto, Ontario, Canada4The Hospital for Sick Children.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Gershon
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Campitelli
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Croxford
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Department of Medicine, University of Toronto, Toronto, Ontario, Canada6University Health Network, Toronto, Ontario, Canada.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Stanbrook
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Department of Medicine, University of Toronto, Toronto, Ontario, Canada4The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ross
authors.initials: R
authors.lastname: Upshur
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada7Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Stephenson
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada5Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Thérèse A
authors.initials: TA
authors.lastname: Stukel
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000150:complications; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D012306:Risk
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists