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Efficacy and Safety of Inhaled Bronchodilator Versus Inhaled Bronchodilator/Inhaled Corticosteroid in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease
J. Kor. Soc. Health-syst. Pharm. 2021;38:224-234
Published online May 31, 2021;
© 2021 Korean Society of Health-System Pharmacists

Soo Kyung Lee, Hyo Jung Kang, Jeong Yi Yoon, Eyn Young Kwon and Jin Suk Kang

Department of Pharmacy, Seoul St. Mary’s Hospital, The Catholic University of Korea 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
Correspondence to: 이수경 Tel:02-2258-2533
Received October 13, 2020; Revised November 20, 2020; Accepted December 16, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background : According to the treatment guidelines for Chronic Obstructive Pulmonary Disease (COPD), long-acting β2 agonists (LABA) and long-acting muscarinic antagonists (LAMA) are recommended. Addition of inhaled corticosteroid (ICS) is more effective in reducing acute exacerbations in patients with exacerbations and moderate to very severe COPD, but some studies have shown that it could increase the risk of pneumonia. Therefore, this study was conducted to evaluate the efficacy and safety of LABA/LAMA versus LABA/LAMA/ICS.
Methods : Between January 2016 and June 2017, medical records of patients with moderate to severe COPD who visited the Department of Pulmonology in one hospital and started using LABA/LAMA (dual therapy) or LABA/LAMA/ICS (triple therapy) were reviewed retrospectively. The efficacy between in the two groups was evaluated as the number of acute exacerbations and change in pulmonary function. We also analyzed adverse drug reactions including pneumonia.
Results : A total of 53 patients received dual therapy and 47 patients received triple therapy. The rate of acute exacerbations was reduced and change in FEV1 (Forced expiratory volume for 1 second) was improved in each group, but there was no difference between the two groups. Pneumonia occurred in 7.5% of patients receiving dual therapy versus 4.3% of patients receiving triple therapy, and other adverse drug reactions occurred in 11.3% of patients receiving dual therapy versus 4.3% of patients receiving triple therapy.
Conclusion : Reduction in the rate of acute exacerbations in the triple therapy group was not significantly better than that in the dual therapy group, but adverse drug reactions, including pneumonia also did not show a difference between the two groups.
Keywords : Chronic obstructive pulmonary disease (COPD), Inhaled corticosteroid (ICS), Acute exacerbation, Pulmonary function, Pneumonia