TY  - BOOK
AU  - Colice, Gene L
TI  - Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD
SN  - 1176-9106
PY  - 2014///
KW  - *Adrenal Cortex Hormones/ad [Administration & Dosage]
KW  - *Androstadienes/ad [Administration & Dosage]
KW  - *Beclomethasone/ad [Administration & Dosage]
KW  - *Lung/de [Drug Effects]
KW  - *Pulmonary Disease, Chronic Obstructive/dt [Drug Therapy]
KW  - Administration, Inhalation
KW  - Adrenal Cortex Hormones/ae [Adverse Effects]
KW  - Adrenal Cortex Hormones/ch [Chemistry]
KW  - Aged
KW  - Androstadienes/ae [Adverse Effects]
KW  - Androstadienes/ch [Chemistry]
KW  - Anti-Bacterial Agents/tu [Therapeutic Use]
KW  - Beclomethasone/ae [Adverse Effects]
KW  - Beclomethasone/ch [Chemistry]
KW  - Disease Progression
KW  - Emergency Service, Hospital
KW  - Female
KW  - Hospitalization
KW  - Humans
KW  - Lung/pp [Physiopathology]
KW  - Male
KW  - Middle Aged
KW  - Particle Size
KW  - Pulmonary Disease, Chronic Obstructive/di [Diagnosis]
KW  - Pulmonary Disease, Chronic Obstructive/pp [Physiopathology]
KW  - Retrospective Studies
KW  - Severity of Illness Index
KW  - Smoking Cessation
KW  - Smoking/ae [Adverse Effects]
KW  - Smoking/pc [Prevention & Control]
KW  - Time Factors
KW  - Treatment Outcome
KW  - MedStar Washington Hospital Center
KW  - Medicine/Pulmonary-Critical Care
N2  - CONCLUSION: We observed that small-particle ICS at significantly lower doses had comparable effects on exacerbation rates as larger-particle ICS at higher doses, whereas initiation of small-particle ICS was associated with better odds of treatment stability during 2-years' follow-up; PATIENTS AND METHODS: Smokers and ex-smokers with COPD > 40 years old initiating or stepping-up their dose of extrafine beclomethasone or fluticasone were matched 1:1 for demographic characteristics, index prescription year, concomitant therapies, and disease severity during 1 baseline year. During 2 subsequent years, we evaluated treatment 150318 and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection; PURPOSE: Small airway 150318s and dysfunction contribute importantly to airway obstruction in chronic obstructive pulmonary disease (COPD), which is currently treated with inhaled corticosteroids (ICS) and long-acting bronchodilators at Global initiative for Obstructive Lung Disease (GOLD) grades 2-4. This retrospective matched cohort analysis compared effectiveness of a representative small-particle ICS (extrafine beclomethasone) and larger-particle ICS (fluticasone) in primary care patients with COPD; RESULTS: Mean patient age was 67 years, 57%-60% being male. For both initiation (n=334:334) and step-up (n=189:189) patients, exacerbation rates were comparable between extrafine beclomethasone and fluticasone cohorts during the 2 year outcome period. Odds of treatment stability (no exacerbation or treatment 150318) were significantly greater for patients initiating extrafine beclomethasone compared with fluticasone (adjusted odds ratio 2.50; 95% confidence interval, 1.32-4.73). Median ICS dose exposure during 2 outcome years was significantly lower (P<0.001) for extrafine beclomethasone than fluticasone cohorts (315 mug/day versus 436 mug/day for initiation, 438 mug/day versus 534 mug/day for step-up patients)
UR  - http://dx.doi.org/10.2147/COPD.S68289
ER  -