A Cochrane review [Abstract] 1 on inhaled corticosteroids (ICS) compared to long-acting beta2-agonists (LABA) in patients with stable chronic obstructive pulmonary disease (COPD) included 7 trials, with a total of 5 997 participants. Trial duration was from 6 months to 3 years. All trials compared ICS/LABA combination inhalers with LABA and ICS as individual components. There was no statistically significant difference in the number of patients experiencing exacerbations (OR 1.22; 95% CI 0.89 to 1.67), or the rate of exacerbations per patient year (RR 0.96; 95% CI 0.89 to 1.02) between the ICS and LABA groups. Patients treated with LABAs showed greater improvements in pre-bronchodilator FEV1 (MD 18.99 ml; 95% CI 0.52 to 37.46). The incidence of pneumonia was significantly higher among patients on ICS (OR 1.38; 95% CI 1.10 to 1.73). Mortality was higher in patients on ICS (Peto OR 1.17; 95% CI 0.97 to 1.42), although the difference was not statistically significant. There were no statistically significant differences between ICS and LABA in the number of hospitalisations due to exacerbations, number of mild exacerbations, peak expiratory flow, dyspnoea, symptoms scores, use of rescue medication, adverse events, all cause hospitalisations, or withdrawals from studies. Greater improvements in health-related quality of life were observed in patients receiving ICS (St George's Respiratory Questionnaire, SGRQ: MD -0.74; 95% CI -1.42 to -0.06).
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