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Toronto (May 15, 2016) – In a study published on May 15 in the New England Journal of Medicine, trial results showed that a once daily dose of dual bronchodilators was more effective than a commonly used twice daily corticosteroi/bronchodilator inhaler at improving lung function in patients suffering from Chronic Obstructive Pulmonary Disorder (COPD).
Furthermore, the combination – an inhaled long-acting β2-agonist (LABA) with an inhaled long-acting muscarinic antagonist (LAMA), or LABA/LAMA – was more effective and consistent in preventing COPD flare-ups whether they were mild, moderate or severe exacerbations.
"These results are very encouraging for COPD patients prone to exacerbations," says Dr. Kenneth Chapman, Director, Asthma and Airways Centre, Toronto Western Hospital and the lead Canadian researcher in the trial. "Patients who experience several flare-ups a year lose breathing capability more quickly and die sooner than those who don't. By 2020, COPD is expected to be the third most common disease on the planet, especially among women, so we need to be able to offer the best treatment available to its sufferers."
The trial, called FLAME, was funded by Novartis.
COPD is a chronic lung disease that includes chronic bronchitis and emphysema. According to the Canadian Lung Association, COPD is mostly caused by smoking but can also result from second hand smoke, genetics, occupational dust/smoke, wood smoke or biomass fuels used for cooking, and having lung infections in childhood. In 2010, over 770,000 Canadians age 35 or older were living with the disease.
In addition to these symptoms, COPD is also characterized by "flare-ups" which can lead to disability, hospitalization and, in some cases, death. Flare-ups occur when COPD symptoms suddenly worsen or new symptoms develop with episodes lasting several days.
Most guidelines recommend a long-acting β2-agonist combined with an inhaled corticosteroid (LABA/ICS) for COPD treatment for patients with high exacerbation risk. Inhaled steroids, when used over a long period of time, can increase the risk of pneumonia and other side-effects associated with steroids.
In this randomized, double-blind, double-dummy trial over a 52 week period, researchers compared a once daily LABA/LAMA with a twice-daily LABA/ICS in COPD patients with a history of one or more exacerbations in the preceding year to determine if combination bronchodilators were more effective. The results showed that the LABA/LAMA was not only as effective as a LABA/ICS combination, but was also consistently superior for all exacerbation outcomes, lung function and health status.
"Bronchodilators were the foundation of care for COPD before research began to focus more on inhaled corticosteroids," says Chapman who, in 1992, wrote the first Canadian guidelines for COPD management. "These results indicate we should get back to basics with COPD treatments as they are proving to be more effective and much safer."
The FLAME trial is the first in a series of studies, one of which will evaluate the long term use of LABA/LAMA.
Toronto Western Hospital has been serving the health care needs of its culturally diverse local community for more than 100 years. Home to the Krembil Neuroscience Centre, one of the largest combined clinical and research neurological facilities in North America, the Toronto Western Hospital is a leader in medical research and also offers expertise in community and population health and musculoskeletal health and arthritis. The Toronto Western Hospital, along with the Princess Margaret Cancer Centre, Toronto General Hospital and Toronto Rehabilitation Institute, is a member of the University Health Network and is affiliated with the University of Toronto.
University Health Network consists of Toronto General and Toronto Western Hospitals, the Princess Margaret Cancer Centre, Toronto Rehabilitation Institute, and The Michener Institute for Education at UHN. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto.
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