CHEST Guidelines-Further-Evidence-of-Varying-Risks-and-Benefits-of-

Further-Evidence-of-Varying-Risks-and-Benefits-of-

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The editorial by Donald P. Tashkin, published in the journal CHEST, reviews the study by Chang et al., which analyzed the risks and benefits of different inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) combinations in COPD treatment. ICS/LABA combinations are known for reducing COPD exacerbations, but concerns exist about the safety of ICS, particularly an increased risk of pneumonia. The study by Chang et al. utilized national claims data from Taiwan to compare the risk of severe pneumonia and effectiveness in reducing severe adverse events among COPD patients using different ICS/LABA combinations, specifically focusing on fluticasone, budesonide, and beclomethasone.<br /><br />Budesonide and beclomethasone, when combined with LABA, were associated with a lower risk of severe pneumonia compared to fluticasone combinations. Fluticasone showed a dose-response effect on severe pneumonia risk that was not apparent with budesonide or beclomethasone. The benefits of budesonide and beclomethasone in reducing severe adverse events were found to be greater than fluticasone, although the benefits became nonsignificant after adjusting for fluticasone-equivalent dosages.<br /><br />This comparison suggests that non-fluticasone ICS might offer a better risk/benefit profile due to lower pneumonia risk and comparable efficacy in reducing severe exacerbations. However, the study calls for further research to confirm these findings. Harmful effects of ICS should be weighed against their potential benefits in reducing severe COPD exacerbations, which are the key contributors to the disease's economic burden. Chang et al.’s findings underscore the importance of considering both the effectiveness and safety of COPD treatments, particularly in the context of hospitalized events, which pose greater health risks and economic costs.

Keywords

COPD treatment

ICS/LABA combinations

severe pneumonia

fluticasone

budesonide

beclomethasone

pneumonia risk

COPD exacerbations

Chang et al.

safety and efficacy