Using Long-Acting Muscarinic Antagonist in COPD

2016 GOLD guidelines recommend EITHER LABA + ICS or LAMA for COPD patients at risk for exacerbation.
Some studies have shown ICS associated with lower risk of exacerbations (esp if eosinophilia or COPD/asthma overlap), may be associated with increased risk for PNA.
Industry-funded study.
n = 3362 patients with COPD and at least 1 exacerbation in previous year.
Randomized to indacaterol/glycopyrronium (LABA/LAMA combo) vs BID salmeterol/fluticasone.
At one year, significantly fewer exacerbations in the LABA/LAMA group (3.59 v 4.03 / patient).
Benefit seen in patients with or without eosinophilia.
Adverse events similar.  No excess PNA seen in LABA/ICS group.
N Engl J Med 2016 May 15
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