Using two asthma drugs as combined therapy reduces mortality among patients with chronic obstructive pulmonary disease (COPD) more than one drug alone, according to the largest COPD trial ever done.

Researchers in the United States and several European countries randomized 6,112 patients (aged 40-80 years) with moderate-to-severe COPD to placebo, the long-acting bronchodilator salmeterol (50 µg), the corticosteroid fluticasone propionate (500 µg), or both drugs. All the regimens were given twice daily. After three years, all-cause mortality reached 12.6% in the combination-therapy group vs. 15.2% in the placebo group. COPD-related mortality was 4.7% in the combination group vs. 6.0% in placebo patients. Neither salmeterol nor fluticasone alone was significantly better than placebo.

The incidence of moderate-to-severe exacerbations was reduced 25% in the combined therapy group compared with placebo. Health status as measured by a respiratory questionnaire was also better than with either drug alone or placebo. Side effects of the dual therapy included pneumonia, hoarseness, and oral thrush.

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The combined therapy is marketed as Advair and is made by GlaxoSmithKline, which sponsored the study. The findings were presented at the American College of Chest Physicians annual meeting in Salt Lake City by Bartolome R. Celli, MD, professor of medicine at Tufts University School of Medicine in Boston. Referring to Advair, he says, “Now we can add to oxygen therapy and smoking cessation another type of therapy that impacts COPD mortality.”