60yo M COPD and remote hx TB (>30yrs ago) p/w worsening SOB | Figure 1

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60yo M COPD and remote hx TB (>30yrs ago) p/w worsening SOB and hypoxia. 3 days into admission, got cough and bloody sputum. CXR shows R lower lobe infiltrate. The second CXR (on the R) is taken 5 days after initial presentation. The chest CT corresponds to the second CXR. Ddx for unilateral progressive lung findings?

Why you should join Figure 1

Which combination of inhaled medications are safe and effective for chronic obstructive pulmonary disease (COPD)?

Key messages

What is chronic obstructive pulmonary disease, and how is it treated? Chronic obstructive pulmonary disease (COPD) is a long‐term lung condition characterised by cough, sputum production. Healthcare guidelines now recommend that people with stable, high‐risk COPD use inhalers containing either a combined LAMA+LABA medicine or a combined LABA plus inhaled corticosteroid (LABA+ICS) medicine.

What did we want to find out? We examined the findings of trials that randomised people to receive either LAMA+LABA or LABA+ICS to see how they compare.

What did we find? We included 19 studies involving 22,354 participants. The studies lasted from 6 to 52 weeks. The studies included more men than women (approximately 70% of participants were men), and the people in the studies were about 64 years old. Most studies included people with moderate to severe COPD. Pharmaceutical companies were involved in most of the studies, which might affect how much we can trust the results.

Compared to LABA+ICS, LAMA+LABA led to an improvement in lung function, reduced pneumonia from 5% to 3% but increased the risk of death from 1% to 1.4%. LAMA+LABA probably made little to no difference to COPD exacerbations (flare‐ups) compared to LABA+ICS. People in each of the treatment groups reported similar quality of life scores and were about as likely to experience serious side effects, which were rare.

What are the limitations of the evidence? Our confidence in the evidence was moderate to high because the included studies were well‐designed and had a sufficient number of participants with mainly moderate to severe COPD.

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