People with severe chronic obstructive pulmonary disease (COPD), usually known as emphysema, are helped considerably when they take a combination of two inhaled drugs -- the long-acting beta-2 agonist salmeterol, which relaxes airways, and the inhaled corticosteroid fluticasone to fight inflammation, according to a new study.

"We saw a ... highly relevant 35 percent reduction in COPD exacerbations, if fluticasone was given with salmeterol in a combination inhaler Seretide, or Advair," Dr. Peter Kardos from Maingau Hospital, Frankfurt am Main, Germany, told Reuters Health.

In a study, 994 patients with COPD were assigned to daily treatment with either the salmeterol/fluticasone combination or salmeterol alone. A total of 792 patients completed the 44-week study.

As reported in the American Journal of Respiratory and Critical Care Medicine, the total number of flare-ups was 324 in the combination therapy group and 464 in the salmeterol group. That translates to an annualized rate of exacerbations per patient of 0.92 and 1.40, respectively, or a 35 percent decrease in COPD flare-ups with combination therapy.

Other measures, including health-related quality of life, peak expiratory flow, and use of rescue medication, also favored combination therapy.

However, 23 cases of pneumonia occurred in the combination-treatment group compared with 7 in the salmeterol-only group.

This represents an excess pneumonia rate of about 3 cases every year for every 100 patients treated with the combination therapy, note Drs. Dennis E. Niewoehner and Timothy J. Wilt of the VA Medical Center and the University of Minnesota, Minneapolis, in an editorial.

Furthermore, they argue that "only a small minority of patients with COPD treated with an inhaled corticosteroid will achieve clinically noticeable improvement in health status."

Therefore, decisions to start combination treatment "should focus on severely symptomatic and exacerbation-prone patients and balance the recently demonstrated benefits against increased drug costs and adverse effects," the editorialists conclude.

SOURCE: American Journal of Respiratory and Critical Care Medicine, second issue for January 2007.