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05-06-2013 | General practice | Article

Diuretic treatment linked to COPD steroid efficacy


Free abstract

medwireNews: Research shows that patients with chronic obstructive pulmonary disease (COPD) benefit the most from the addition of an inhaled corticosteroid to their bronchodilator therapy if they are receiving diuretics or show significant bronchodilator reversibility.

By contrast, patients who were neither taking diuretics nor were bronchodilator responsive did not experience a significant reduction in exacerbations when they received fluticasone propionate in addition to salmeterol.

The study, reported in BMJ Open, included data from two randomized trials on 771 patients who received twice-daily salmeterol/fluticasone propionate 50/250 µg, and 772 patients who received salmeterol 50µg.

In the year prior to the study, 37% of patients had experienced two or more moderate exacerbations and 2% had two or more severe exacerbations.

Overall, use of salmeterol/fluticasone propionate was associated with a significant 30% lower rate of moderate or severe exacerbations compared with salmeterol alone.

But in patients who were being treated with diuretics (n=454), the decline in exacerbations was even greater at 44%. And, patients not taking diuretics but who demonstrated a post-bronchodilator change of forced expiratory volume in 1 second of at least 12% (n=756), experienced a decline of 33% when treated with the combined inhaler.

Conversely, in patients who were not taking diuretics and did not demonstrate bronchodilator reversibility (n= 333), there was no difference in the rate of exacerbations with salmeterol/fluticasone or salmeterol alone.

The authors, Rachael DiSantostefano (GlaxoSmithKline, Durham, North Carolina, USA) and colleagues, say that the decline in exacerbation rate among patients taking diuretics is particularly noteworthy and may be attributed to such patients having, or being at risk for, cardiovascular disease (CVD).

They suggest that concomitant CVD may reflect increased inflammation related to COPD, or CVD may drive COPD exacerbations and their severity. Additionally, it is plausible that the direct activity of diuretics may complement salmeterol/fluticasone combination treatment.

"Our findings and those of others, suggest that patients with multiple diseases may benefit from a different approach to management than those with a single disease, a concept which has recently been raised as a major issue in primary care," say the authors.

They add: "This study highlights the future potential for a personalized medicine approach to the treatment of patients with COPD."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Kirsty Oswald, medwireNews Reporter

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