{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T03:06:05Z","timestamp":1773111965464,"version":"3.50.1"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Inhaled corticosteroid (ICS)\u2013long-acting \u03b2-agonist (LABA) inhalers are generally considered therapeutically equivalent when treating chronic obstructive pulmonary disease (COPD). However, metered-dose inhalers in the class are associated with substantially higher greenhouse gas emissions than dry powder formulations, and studies have raised questions about potential intraclass differences in clinical outcomes among patients receiving ICS-LABAs.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To analyze COPD exacerbations and pneumonia hospitalizations associated with once-daily fluticasone furoate\u2013vilanterol dry powder inhalers, twice-daily fluticasone propionate\u2013salmeterol dry powder inhalers, and twice-daily budesonide-formoterol metered-dose inhalers in adults with COPD.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study was conducted using longitudinal commercial claims data of US adults aged 40 years or older with COPD. Patients were 1:1 pairwise propensity score matched into 3 cohorts: (1) new users receiving fluticasone furoate\u2013vilanterol vs budesonide-formoterol between January 1, 2014, and February 29, 2024; (2) new users receiving fluticasone furoate\u2013vilanterol vs fluticasone propionate\u2013salmeterol between January 1, 2014, and February 29, 2024; and (3) new users receiving fluticasone propionate\u2013salmeterol vs budesonide-formoterol between January 1, 2007, and February 29, 2024.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Receipt of a once-daily fluticasone furoate\u2013vilanterol dry powder inhaler (Breo Ellipta; GSK), twice-daily fluticasone propionate\u2013salmeterol dry powder inhaler (Advair Diskus; GSK), or twice-daily budesonide-formoterol metered-dose inhaler (Symbicort; AstraZeneca).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were first moderate or severe COPD exacerbation and first pneumonia hospitalization. Hazard ratios and 95% CIs were estimated using Cox proportional hazards regression models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The cohorts included 38\u202f070 matched pairs of patients receiving fluticasone furoate\u2013vilanterol vs budesonide-formoterol (58.8% women; mean [SD] age, 71.0 [9.0] years), 20\u202f471 matched pairs of patients receiving fluticasone furoate\u2013vilanterol vs fluticasone propionate\u2013salmeterol (58.3% women; mean [SD] age, 69.9 [9.2] years), and 55\u202f627 matched pairs of patients receiving fluticasone propionate\u2013salmeterol vs budesonide-formoterol (56.2% women; mean [SD] age, 68.3 [9.0] years). Patients receiving fluticasone furoate\u2013vilanterol had a 9% lower risk of moderate or severe COPD exacerbations compared with those receiving budesonide-formoterol (hazard ratio [HR], 0.91 [95% CI, 0.88-0.94]; number needed to treat [NNT]\u2009=\u200940) and a 6% lower risk compared with those receiving fluticasone propionate\u2013salmeterol (HR, 0.94 [95% CI, 0.89-0.98]; NNT\u2009=\u200940). The risk of moderate or severe COPD exacerbation was similar for patients receiving fluticasone propionate\u2013salmeterol and budesonide-formoterol (HR, 0.98 [95% CI, 0.95-1.01]). No differences were observed in the risk of pneumonia hospitalization across the 3 cohorts (fluticasone furoate\u2013vilanterol vs budesonide-formoterol: HR, 1.03 [95% CI, 0.96-1.11]; fluticasone furoate\u2013vilanterol vs fluticasone propionate\u2013salmeterol: HR, 0.93 [95% CI, 0.85-1.03]; and fluticasone propionate\u2013salmeterol vs budesonide-formoterol: HR, 1.04 [95% CI, 0.98-1.10]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of new ICS-LABA users with COPD, once-daily dry powder fluticasone furoate\u2013vilanterol inhalers were associated with slightly improved clinical outcomes compared with twice-daily metered-dose budesonide-formoterol inhalers and twice-daily dry powder fluticasone propionate\u2013salmeterol inhalers. Further studies are needed to explore potential intraclass differences among inhalers used to treat COPD.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.0959","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T15:00:24Z","timestamp":1773068424000},"page":"e260959","source":"Crossref","is-referenced-by-count":0,"title":["Fluticasone- vs Budesonide-Based Dual Therapy for COPD"],"prefix":"10.1001","volume":"9","author":[{"given":"William B.","family":"Feldman","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Now with Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology, and Allergy, 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