Combination therapy of salmeterol and fluticasone improves survival in patients with COPD

A combination of two common medications may help patients with chronic obstructive pulmonary disease (COPD) live longer.

New research presented at CHEST 2006, the 72nd annual international scientific assembly of the American College of Chest Physicians (ACCP), shows that when used in combination, inhaled salmeterol (SAL) and fluticasone propionate (FP) reduced the risk of dying by up to 17.5 percent in patients with COPD. Currently, FP, an inhaled corticosteroid, and SAL, a long-acting B2-agonist bronchodilator, are used alone and in combination to treat both asthma and COPD.

"The combination therapy of salmeterol and fluticasone is the first intervention since oxygen therapy or smoking cessation to show improved survival in patients with COPD," said study author Bartolome R. Celli, MD, FCCP, of Caritas-St. Elizabeth's Medical Center, Boston, MA. "The improvement was comparable with that produced by statins in cardiovascular mortality. This represents an important step forward in the management of COPD."

As part of the TOwards a Revolution in COPD Health (TORCH) study, researchers from the United Kingdom, Denmark, Australia, and the United States investigated whether the combined therapy of salmeterol and fluticasone (FSC) would significantly impact survival in patients with COPD. Patients (n=6,112) with moderate to severe COPD from 42 countries were included in the 3-year, double-blind trial. Of the patients (76 percent men, mean age 65 years), 1,534 received FP; 1,521 received SAL; 1,533 received FSC; and the remaining patients received a placebo. Results were clinically significant, showing that FSC reduced the risk of dying at any time by 18 percent compared with placebo over the 3-year period, with absolute reduction rates being 15.2 percent and 12.6 percent, respectively. Secondary endpoints also were significant, including reduction in exacerbations, improvement in quality of life, and lung function. Furthermore, there was a trend in the reduction in COPD-related mortality with FSC vs placebo (6.0% vs 4.7%). Overall, survival was better for patients on combined therapy than for FP alone. Mortality for the active combination also was lower than for SAL, but the difference was not statistically significant.

"We do not know the exact mechanism by which this combined therapy works better than the separate therapies. We speculate that synergistic action on cell receptors may lead to less muscle contraction or inflammation," said Dr. Celli. "Although we do not expect the combination therapy to replace existing therapies, it will allow greater room for intervention for health-care providers treating patients with COPD."

"COPD is a progressive and debilitating lung disease most often caused by smoking," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "There is no cure for COPD, but smoking cessation and other effective treatments can slow the damage brought about by smoking. Physicians should encourage their patients who smoke to quit in order to avoid further lung damage."