O3.3 Inhaled corticosteroids (ICS) versus long-acting beta₂-agonists (LABA)

A systematic review of inhaled corticosteroids versus long-acting beta-agonists in COPD found similar benefits in exacerbation rates and mortality when comparing these treatments, but there was a higher rate of pneumonia with inhaled corticosteroids (Spencer 2011) [evidence level I]. There were small benefits in FEV₁ (for long-acting beta-agonists) and quality of life (for inhaled corticosteroids). Overall, the authors conclusions supported long-acting beta-agonists as part of frontline therapy for COPD, with regular inhaled corticosteroid therapy as an adjunct in patients experiencing frequent exacerbations (Spencer 2011).