Postma, Dirkje SRoche, NicolasColice, GeneIsrael, ElliotMartin, Richard Jvan Aalderen, Willem MCGrigg, JonathanBurden, AnneHillyer, Elizabeth Vvon Ziegenweidt, JulieGopalan, GokulPrice, David2014-12-022014Postma, D. S., N. Roche, G. Colice, E. Israel, R. J. Martin, W. M. van Aalderen, J. Grigg, et al. 2014. “Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD.” International Journal of Chronic Obstructive Pulmonary Disease 9 (1): 1163-1186. doi:10.2147/COPD.S68289. http://dx.doi.org/10.2147/COPD.S68289.1176-9106http://nrs.harvard.edu/urn-3:HUL.InstRepos:13454828Purpose Small airway changes and dysfunction contribute importantly to airway obstruction in chronic obstructive pulmonary disease (COPD), which is currently treated with inhaled corticosteroids (ICS) and long-acting bronchodilators at Global initiative for Obstructive Lung Disease (GOLD) grades 2–4. This retrospective matched cohort analysis compared effectiveness of a representative small-particle ICS (extrafine beclomethasone) and larger-particle ICS (fluticasone) in primary care patients with COPD. Patients and methods Smokers and ex-smokers with COPD ≥40 years old initiating or stepping-up their dose of extrafine beclomethasone or fluticasone were matched 1:1 for demographic characteristics, index prescription year, concomitant therapies, and disease severity during 1 baseline year. During 2 subsequent years, we evaluated treatment change and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection. Results: Mean patient age was 67 years, 57%–60% being male. For both initiation (n=334:334) and step-up (n=189:189) patients, exacerbation rates were comparable between extrafine beclomethasone and fluticasone cohorts during the 2 year outcome period. Odds of treatment stability (no exacerbation or treatment change) were significantly greater for patients initiating extrafine beclomethasone compared with fluticasone (adjusted odds ratio 2.50; 95% confidence interval, 1.32–4.73). Median ICS dose exposure during 2 outcome years was significantly lower (P<0.001) for extrafine beclomethasone than fluticasone cohorts (315 μg/day versus 436 μg/day for initiation, 438 μg/day versus 534 μg/day for step-up patients). Conclusion: We observed that small-particle ICS at significantly lower doses had comparable effects on exacerbation rates as larger-particle ICS at higher doses, whereas initiation of small-particle ICS was associated with better odds of treatment stability during 2-years’ follow-up.en-USCOPD exacerbationextrafine particlematched cohort analysisreal lifesmall airwaysJournal Article2014-12-0210.2147/COPD.S68289