Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD

Dirkje S Postma, Nicolas Roche, Gene Colice, Elliot Israel, Richard J Martin, Willem Mc van Aalderen, Jonathan Grigg, Anne Burden, Elizabeth V Hillyer, Julie von Ziegenweidt, Gokul Gopalan, David Price

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)
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PURPOSE: Small airway changes 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.

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 change and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection.

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 change) 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 μg/day versus 436 μg/day for initiation, 438 μg/day versus 534 μg/day for step-up patients).

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.

Original languageEnglish
Pages (from-to)1163-1186
Number of pages24
JournalInternational journal of chronic obstructive pulmonary disease
Publication statusPublished - 17 Oct 2014

Bibliographical note

We thank Professor Neil Barnes for his contributions in the early stages of the analyses, and we gratefully acknowledge Victoria Thomas for her assistance with the statistical analyses and production of figures.


  • COPD exacerbation
  • extrafine particle
  • matched cohort analysis
  • real life
  • small airways


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