TY - JOUR T1 - Initial inhaler choice in COPD: real-world evidence JF - Breathe JO - Breathe SP - 350 LP - 352 DO - 10.1183/20734735.0256-2019 VL - 15 IS - 4 AU - Thomas Jones Y1 - 2019/12/01 UR - http://breathe.ersjournals.com/content/15/4/350.abstract N2 - Long-acting bronchodilators are the mainstay of inhaled therapy in COPD. Both long-acting β-agonists (LABA) and long-acting muscarinic antagonists (LAMA) are effective at reducing breathlessness and exacerbation frequency, with LAMA being the more effective of the two classes [1]. The Global Initiative for Chronic Obstructive Lung Disease advises that inhaled corticosteroids (ICS) are reserved for those who exacerbate more frequently and preferably after the addition of dual long-acting bronchodilators [2]. Some people with COPD benefit from ICS, and there is evidence that blood eosinophil count is a useful biomarker to highlight who might benefit [3]. ICS are known to increase the risk of pneumonia in people with COPD [4] but despite the guidelines, many people with COPD are prescribed LABA/ICS combinations as initial inhaled therapy [5]. Suissa et al. [6] reported real-world evidence comparing LABA/ICS with LAMA as the initial treatment of COPD, stratified by blood eosinophil count, detailing both the benefits for exacerbation frequency and risk of pneumonia with each treatment strategy.In a real-world cohort (UK's CPRD), initiating inhaled treatment for COPD with ICS/LABA rather than LAMA improves exacerbation rate without significant increases in pneumonia rates in those with peripheral blood eosinophil counts >4% http://bit.ly/2OZpij5 ER -