Research in context
Evidence before this study
We searched PubMed and ClinicalTrials.gov up to Nov 18, 2015, for published or ongoing studies examining the treatment of patients with concomitant chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) with inhaled corticosteroids or long-acting β agonists with the following search terms: “COPD”, “cardiovascular disease”, “inhaled corticosteroids”, “long-acting beta-agonists”. The search was restricted to English language. The search also used our familiarity with the medical literature and research in progress within the specialty. There were no adequately powered trials, and only a few post-hoc or subgroup analyses of larger trials, to provide clinicians with evidence to make decisions about the treatment of patients with concomitant COPD and CVD.
Added value of this study
Our findings bridge a crucial gap by providing clinicians with evidence regarding inhaled treatments for patients with concomitant moderate COPD and CVD. In this patient group, combined inhaled corticosteroid and long-acting β-agonist treatment had no effect on overall mortality or cardiovascular events. By contrast with inhaled β-agonist therapy, inhaled corticosteroid treatment was associated with a reduction in the rate of decline of lung function. All treatments reduced the rate of moderate and severe exacerbations.
Implications of all of the available evidence
Treatment with a combination of an inhaled corticosteroid and long-acting β agonist has documented benefits in COPD. In patients with moderate COPD and CVD, these benefits do not extend to reductions in overall mortality or cardiovascular events. However, inhaled corticosteroid therapy does seem to inhibit the rate of decline in lung function.