In the matched cohort, 8151 patients had a first moderate or severe exacerbation during 23 983 person-years of follow-up. Patients starting on LAMA-LABA were more likely to have undergone baseline spirometry measurement and more likely to have received their first prescription from a pulmonologist. These patients were also less likely to have had baseline GOLD (Global Initiative for Obstructive Lung Disease) stage E, which is patients with at least 2 moderate and/or 1 severe COPD exacerbation in the last year. Patients starting on LAMA-LABA therapy had fewer moderate and severe exacerbations, as well as fewer pneumonia hospitalizations. Women were more likely to receive ICS-LABA therapy compared with men (51.3% vs 48.6%). Half of the patients were women (50.4%), and the mean age was 70.2 years. There were 137 833 in the cohort: 30 829 started LAMA-LABA therapy and 107 004 started ICS-LABA therapy. They performed a cohort study using commercial claims, with the goal of comparing COPD exacerbation and pneumonia hospitalization of patients started on LAMA-LABA inhalers vs ICS-LABA inhalers.

“Uncertainty about optimal COPD therapy has been further compounded by problems of generalizability in clinical trials for COPD,” the authors added, with the populations treated in clinical practice not matching those enrolled in randomized clinical trials.

Several randomized clinical trials found LAMA-LABA reduced the rate of COPD exacerbations and had fewer pneumonias over ICS-LAMA however, other trials found the opposite. Previous studies had conflicting results regarding the use of LAMA-LABA vs ICS-LABA, they noted.

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