In stable COPD, long-acting muscarinic antagonist plus long-acting beta-agonists resulted in less exacerbations, pneumonia and larger improvement in FEV 1 than long-acting beta-agonists plus inhaled corticosteroids.

Commentary on: Horita N, Goto A, Shibata Y, et al . Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2017;2:CD012066. The Global Initiative for Chronic Obstrictove Lung Disease 2017 report recommends the use of long-acting muscarinic antagonist (LAMA) + long-acting beta-agonist (LABA), or alternatively LABA + inhaled corticosteroid (ICS), in patients with chronic obstructive pulmonary disease (COPD) at risk of exacerbations regardless of the entity of symptoms.1 However, it does not specify whether it is preferable to start with LAMA+LABA rather than LABA+ICS. In fact, no firm conclusions can be drawn from the current literature. The aim of this study was to compare the benefits and harms of LAMA+LABA versus LABA+ICS in the treatment of COPD. The authors conducted a meta-analysis of studies published up to June 2016, including individual randomised controlled trials, parallel-group trials and crossover trials …