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RESEARCH PRODUCT

Switch from LABA+ICS to a LABA/LAMA combination in symptomatic women with COPD – an analysis of the observational DACCORD study

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Introduction: COPD prevalence in women has increased in recent years and the importance of avoiding ICS use in this group, because of its potential negative impact on comorbidities such as osteoporosis and diabetes, has become a topic of interest. In this real-life cohort women with COPD that were switched from LABA+ICS treatment to a fixed combination of LABA/LAMA were followed for 1 year. Methods: DACCORD is a prospective, non-interventional 2-year study in the primary and secondary care setting throughout Germany. Patients were recruited after a change in, or initiation of COPD maintenance medication. Data collected at baseline and every 3 months included moderate/severe exacerbations and COPD medication use. COPD Assessment Test (CAT) data were collected annually. Results: Follow-up data were available for 205 women who switched from LABA+ICS to a LABA/LAMA combination. Of these, 51.2% had cardiovascular comorbidities, 20.5% diabetes and 13.2% osteoporosis. On study entry the mean CAT score was 21.1. In the 6 months before study entry 34.1% of this subgroup vs 24.0% of the total study population (n=4064) experienced an exacerbation. In the 1 year follow-up 21.0% vs 19.7% reported an exacerbation giving low annualized exacerbation rates (0.34; 95% CI [0.24, 0.48] vs 0.30; 95% CI [0.28, 0.32]). Treatment persistence was high (83.4% vs 86.4%). Conclusions: Dual bronchodilation with a combination of LABA and LAMA is a valid treatment option for symptomatic women with COPD, thereby avoiding the burden of ICS. This is consistent with recent recommendations from GOLD 2018, which describe dual bronchodilation as the foundation of pharmacological COPD therapy.