A comparison of the real-life clinical effectiveness of the leading licensed ICS/LABA combination inhalers in the treatment for COPD

Simon Wan Yau Ming, John Haughney, Dermot Ryan, Iain Small, Federico Lavorini, Alberto Papi, Dave Singh, David M. G. Halpin, John R. Hurst, Shishir Patel, Matthias Ochel, Janwillem W. H. Kocks, Victoria Carter, Antony Hardjojo, David Price* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Fostair® 100/6 (BDP/FF) pressurized metered dose inhaler (pMDI) delivered in an extrafine formulation is licensed for asthma and COPD in the UK. However, its real-life effectiveness for COPD has not been evaluated. This study compared the clinical effectiveness of BDP/FF against other licensed ICS/LABA combination inhalers: Seretide® Accuhaler® (FP/SAL) and Symbicort® Turbohaler® (BUD/FF).


A matched historical cohort study was conducted using records of patients with diagnostic codes for COPD from the Optimum Patient Care Research Database (OPCRD). Patients who received BDP/FF as their first ICS/LABA were matched 1:1 with patients who received FP/SAL or BUD/FF, resulting in two matched comparisons. Additional analysis was conducted on patients who never had diagnostic codes for asthma. Non-inferiority in terms of the proportion of patients with moderate/severe COPD exacerbation on the different inhalers in the following year was assessed. Non-inferiority was achieved if the higher confidence interval was ≤1.2.


This study included 537 and 540 patient pairs in the BDP/FF vs FP/SAL cohort and the BDP/FF vs BUD/FF cohort respectively. The proportion of patients with COPD exacerbations in the BDP/FF group was not significantly different to both FP/SAL (68.7% vs 70.2%; adjOR, 0.89 [0.67 – 1.19]) and BUD/FF groups (68.5% vs 69.4%; adjOR, 0.79 [0.58 – 1.08]). Non-inferiority of BDP/FF in preventing COPD exacerbation was fulfilled in both comparisons.

In patients without asthma, BDP/FF was also non-inferior to BUD/FF (proportion with COPD exacerbation: 67.8% vs 64.7%; adjOR, 0.79 [0.51 – 1.1997]). Additionally, significantly lower proportion of patients prescribed BDP/FF had COPD exacerbation compared to FP/SAL (64.8% vs 73.7%, adjOR, 0.64 [0.43 – 0.96]).


Initiating ICS/LABA treatment of COPD with extrafine formulation BDP/FF was non-inferior in preventing moderate/severe exacerbations compared to FP/SAL and BUD/FF.
Original languageEnglish
Pages (from-to)3093-3103
Number of pages11
JournalInternational journal of chronic obstructive pulmonary disease
Publication statusPublished - 26 Nov 2020

Bibliographical note


The authors extend their thanks to Dr. Kevin Gruffydd-Jones for his clinical and scientific input in the conduct and writing of this study. Dave Singh is supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC).


This study was funded by Chiesi Limited. The sponsor is involved in the design and presentation of the study.


  • Metered Dose Inhaler
  • Dry Powder Inhaler
  • Chronic Obstructive Pulmonary Disease
  • Treatment efficacy
  • Cost effectiveness
  • Chronic obstructive pulmonary disease
  • Dry-powder inhaler
  • Metered-dose inhaler
  • Cost-effectiveness
  • cost-effectiveness
  • metered-dose inhaler
  • dry-powder inhaler
  • chronic obstructive pulmonary disease
  • treatment efficacy


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