A Study to Evaluate the Effectiveness of Inhaled Corticosteroid/Long-Acting Beta Agonist Combination and Assessment of Health-Related Quality of Life Among COPD Patients on this Therapy
Background: Do combined inhalers offer additional benefits or harms in people with chronic obstructive pulmonary disease compared with the bronchodilator alone? The present study was conducted to evaluate the effectiveness of inhaled corticosteroid/long acting beta agonist combination and to assess the health related quality of life among COPD patients. Methods: A prospective, comparative study was conducted in department of Pulmonary Medicine, Government Medical College and Rajindra Hospital, Patiala. A total of 80 patients were enrolled, and randomly allocated in two groups with 40 patients in each group. In group 1- Budesonide/formoterol (200/6 µg or 400/6 µg), and in group 2- Fluticasone/salmeterol (250/50 µg) was prescribed. The effectiveness was evaluated by assessing exacerbation rate, and breathlessness Modified Medical Research Council (mMRC) grade. Health related quality of life was assessed using St. George’s Respiratory Questionnaire (SGRQ). All the observations thus made were statistically analyzed using chi-square test and t-test. Results: In present study, male patients (n=63) were more than female patients (n=17). In group 1 significant improvement was observed in breathlessness mMRC grade between visit 0 and 2nd (x2 = 8.50, p=0.004), and between visit 1st and 2nd (x2 = 7.24, p=0.007). Similarly, among group 2, significant improvement was seen in mMRC grade between visit 0 and 2nd (x2 = 8.39, p=0.004), and between visit 1st and 2nd (x2 = 5.05, p=0.025). But, no significant difference was seen between group 1 and 2 mMRC grade (p > 0.05). There was no statistically significant difference between group 1 and group 2 exacerbation episodess (x2 = 2.13,p>0.05). In SGRQ mean total score, no significant difference was present between group 1 and 2 (p>0.05). Conclusions: Budesonide Formoterol (BFC) and Fluticasone Salmeterol (FSC) belongs to same group of drug class i.e. inhaled corticosteroid with long acting beta agonist combination and are used to treat exacerbations in moderate to severe COPD patients. BFC and FSC are equally effective in present study.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Kaur, A. P., Sehgal, V. K., Singh, J., Singh, S. P., & Raju, M. (2021). A Study to Evaluate the Effectiveness of Inhaled Corticosteroid/Long-Acting Beta Agonist Combination and Assessment of Health-Related Quality of Life Among COPD Patients on this Therapy. International Journal of Medical and Dental Sciences, 1968–1980. https://doi.org/10.18311/ijmds/2021/26829
- Chronic Obstructive Pulmonary Disease [Internet]. World Health Organization (WHO): Geneva; 2017 [cited January 2021]. Available from: https://www.who.int/news-room/fact-sheets/detail/chronicobstructivepulmonary-disease(copd)
- Global strategy for the diagnosis, management, and prevention of Chronic Obstructive Pulmonary Disease (2020 Report) [Internet]. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2020 [cited 2020]. Available from: https://goldcopd.org/gold-reports/
- Ho T, Cusack RP, Chaudhary N, Satia I, Kurmi OP. Under- and over-diagnosis of COPD: a global perspective. Breathe (Sheff). Mar 2019; 15(1): 24–5. https://doi.org/10.1183/20734735.0346-2018
- Hossain MM, Sultana A, Purohit N. Burden of Chronic Obstructive Pulmonary Disease in India: Status, Practices and Prevention. Int J Pul & Res Sci. Apr 2018; 2(5): 1–4. https://doi.org/10.19080/IJOPRS.2018.02.555599
- Yang IA, Clarke MS, Sim EH, Fong KM. Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012; 7(7): CD002991. https://doi.org/10.1002/14651858.CD002991.pub3
- Nannini LJ, Lasserson TJ, Poole P. Combined corticosteroid and long-acting beta 2 agonist in one inhaler vs long-acting beta 2 agonist for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2012; 9(9): CD006829. https://doi.org/10.1002/14651858.CD006829.pub2
- Nannini LJ, Poole P, Milan SJ, Kesterton A. Combined corticosteroid and long-acting beta 2 agonist in one inhaler vs inhaled corticosteroid alone for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2012; 9(9): CD006829. https://doi.org/10.1002/14651858.CD006826.pub2
- HRQOL Concepts: Health-Related Quality of Life (HRQOL) [Internet]. USA: Centers for Disease Control and Prevention (CDC); 2018 [cited January 2021]. Available from: https://www.cdc.gov/hrqol/concept.htm
- Jones P. St George’s Respiratory Questionnaire Manual: Version 2.3. June 2009; 1–14.
- Jones PW, Adamek L, Nadeau G, Banik N. Comparisons of health status scores with MRC grades in COPD: implications for the GOLD 2011 classification. Eur Respir J. Sep 2013; 42(3): 647–54. https://doi.org/10.1183/09031936.00125612
- Blais L, Forget A, Ramachandran S. Relative effectiveness of Budesonide /formoterol and fluticasone propionate/salmeterol in a 1-year, population based, matched-cohort study of patients with chronic obstructive pulmonary disease (COPD): Effect on COPD-related exacerbations, emergency department visits and hospitalizations, medication utilization, and treatment adherence. Clin Ther. 2010; 32(7): 1320–8. https://doi.org/10.1016/j.clinthera.2010.06.022
- Roberts M, Mapel D, Petersen H, Blanchette C, Ramachandran S. Comparative effectiveness of budesonide/ formoterol and fluticasone/salmeterol for COPD management. J Med Econ. 2011; 14(6): 769–76. https://doi.org/10 .3111/13696998.2011.622817
- Perrone V, Sangiorgi D, Buda S, Esposti LD. Comparative analysis of budesonide/formoterol and fluticasone/salmeterol combinations in COPD patients: findings from a real-world analysis in an Italian setting. Int J COPD. 2016; 11: 2749–55. https://doi.org/10.2147/COPD.S114554
- Partridge MR, Schuermann W, Beckman O, Persson T, Polanowski T. Effect on lung function and morning activities of budesonide/formoterol versus salmeterol/fluticasone in patients with COPD. Ther Adv Respir Dis. 2009; 3(4): 1–11. https://doi.org/10.1177/1753465809344870
- Zhong N, Zheng J, Wen F, Yang L, Chen P, Xiu Q et al., Efficacy and safety of budesonide/formoterol via a dry powder inhaler in Chinese patients with chronic obstructive pulmonary disease. Curr. Med. Res. Jan 2012; 28(2): 257–65. https://doi.org/10.1185/03007995.2011.636420
- Obaseki DO, Erhabor GE, Awopeju OF, Obaseki JE, Adewole OO. Determinants of health-related quality of life in a sample of patients with chronic obstructive pulmonary disease in Nigeria using the St. George’s respiratory questionnaire. Afr Health Sci. Sep 2013; 13(3): 694–702. https://doi.org/10.4314/ahs.v13i3.25
- Müllerova H, Gelhorn H, Wilson H, Benson VS, Karlsson N, Menjoge S et al., St George’s Respiratory Questionnaire Score Predicts Outcomes in Patients with COPD: Analysis of Individual Patient Data in the COPD Biomarkers Qualification Consortium Database. Chronic Obstr Pulm Dis. 2017; 4(2):141–9. https://doi.org/10.15326/jcopdf.4.2.2017.0131
- Ayora AF, Macia-Soler L, Orts-Cortés MI, Hernández C, Seijas-Babot N. Comparative analysis of the psychometric parameters of two quality-of-life questionnaires, the SGRQ and CAT, in the assessment of patients with COPD exacerbations during hospitalization: A multicenter study. Chron Respir Dis. Nov 2018; 15(4): 374–83. https://doi.org/10.1177/1479972318761645
- Tang B, Wang J, Luo L, Li Q, Huang D. Comparative Efficacy of Budesonide/Formoterol with Budesonide, Formoterol or Placebo for Stable Chronic Obstructive Pulmonary Disease: A Meta-Analysis. Med Sci Monit. 2018; 25: 1155– 63. https://doi.org/10.12659/MSM.912033