What do systematic reviews say?

Combined inhalers vs placebo (outcomes

Combined inhalers probably leads to lower annual exacerbation rates compared with placebo (primary outcomes) (moderate certainty).

• Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
  Rate ratio 0.73 [0.69, 0.78]
  7473 participants
  Moderate

Combined inhalers vs placebo (outcomes

Combined inhalers probably leads to lower participants with at least one exacerbation Duration of six months3 compared with placebo (primary outcomes) (moderate certainty).

• Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
  OR 0.78 [0.66, 0.93]
  3141 participants
  Moderate

Combined inhalers vs placebo (outcomes

Combined inhalers probably leads to lower mortality Duration of 18 months3 compared with placebo (primary outcomes) (moderate certainty).

• Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
  OR 0.82 [0.68, 0.99]
  16 studies · 10129 participants
  Moderate

Combined inhalers vs placebo (outcomes

Combined inhalers probably leads to higher pneumonia Duration of 18 months3 compared with placebo (primary outcomes) (moderate certainty).

• Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
  OR 1.62 [1.36, 1.94]
  14 studies · 9620 participants
  Moderate

Combined inhalers vs placebo (outcomes

Combined inhalers showed no clear difference in hospitalisations due to COPD exacerbations Duration of 18 months3 compared with placebo (primary outcomes) (low certainty).

• Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
  OR 0.93 [0.81, 1.06]
  12 studies · 9492 participants
  Low

Combined inhalers vs LABA

Combined inhalers may leads to lower annual Exacerbation Rates compared with LABAs (low certainty).

• Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus long‐acting beta₂‐agonists for chronic… 2012 · Cochrane Headline outcomes only
  Rate ratio 0.76 [0.68, 0.84]
  9 studies · 99211 participants
  Low

Combined inhalers vs LABA

Combined inhalers probably leads to lower number of people experiencing one or more exacerbations compared with LABAs (moderate certainty).

• Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus long‐acting beta₂‐agonists for chronic… 2012 · Cochrane Headline outcomes only
  OR 0.83 [0.7, 0.98]
  6 studies · 3357 participants
  Moderate

Combined inhalers vs LABA

It is very uncertain whether combined inhalers changes annual hospitalisation rates compared with LABAs (very low certainty).

• Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus long‐acting beta₂‐agonists for chronic… 2012 · Cochrane Headline outcomes only
  Rate ratio 0.79 [0.55, 1.13]
  3 studies · 48791 participants
  Very low

Combined inhalers vs LABA

Combined inhalers showed no clear difference in mortality compared with LABAs (moderate certainty).

• Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus long‐acting beta₂‐agonists for chronic… 2012 · Cochrane Headline outcomes only
  OR 0.92 [0.76, 1.11]
  10 studies · 10681 participants
  Moderate

Combined inhalers vs LABA

Combined inhalers probably leads to higher pneumonia compared with LABAs (moderate certainty).

• Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus long‐acting beta₂‐agonists for chronic… 2012 · Cochrane Headline outcomes only
  OR 1.55 [1.2, 2.01]
  12 studies · 11076 participants
  Moderate

Once‐daily ICS/LABA combined inhalers vs once‐daily LAMA

It is very uncertain whether once‐daily ICS/LABA combined inhalers changes mortality (all‐cause) compared with once‐daily LAMA (very low certainty).

• Once‐daily long‐acting beta₂‐agonists/inhaled corticosteroids combined inhalers versus inhaled long‐acting muscarinic… 2018 · Cochrane Headline outcomes only
  OR 0.2 [0.02, 1.73]
  2 studies · 880 participants
  Very low

Once‐daily ICS/LABA combined inhalers vs once‐daily LAMA

It is very uncertain whether once‐daily ICS/LABA combined inhalers changes any COPD exacerbation that requires short‐burst oral corticosteroids… compared with once‐daily LAMA (very low certainty).

• Once‐daily long‐acting beta₂‐agonists/inhaled corticosteroids combined inhalers versus inhaled long‐acting muscarinic… 2018 · Cochrane Headline outcomes only
  OR 0.72 [0.35, 1.5]
  2 studies · 880 participants
  Very low

Once‐daily ICS/LABA combined inhalers vs once‐daily LAMA

It is very uncertain whether once‐daily ICS/LABA combined inhalers changes pneumonia compared with once‐daily LAMA (very low certainty).

• Once‐daily long‐acting beta₂‐agonists/inhaled corticosteroids combined inhalers versus inhaled long‐acting muscarinic… 2018 · Cochrane Headline outcomes only
  OR 6.12 [0.73, 51.24]
  2 studies · 880 participants
  Very low

Once‐daily ICS/LABA combined inhalers vs once‐daily LAMA

• Once‐daily long‐acting beta₂‐agonists/inhaled corticosteroids combined inhalers versus inhaled long‐acting muscarinic… 2018 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 779 participants
  Very low

Once‐daily ICS/LABA combined inhalers vs once‐daily LAMA

It is very uncertain whether once‐daily ICS/LABA combined inhalers changes hospital admissions (all‐cause) compared with once‐daily LAMA (very low certainty).

• Once‐daily long‐acting beta₂‐agonists/inhaled corticosteroids combined inhalers versus inhaled long‐acting muscarinic… 2018 · Cochrane Headline outcomes only
  OR 0.96 [0.49, 1.89]
  2 studies · 880 participants
  Very low

Once‐daily ICS/LABA combined inhalers vs once‐daily LAMA

The review found no eligible studies for this question.

• Once‐daily long‐acting beta₂‐agonists/inhaled corticosteroids combined inhalers versus inhaled long‐acting muscarinic… 2018 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Once‐daily ICS/LABA combined inhalers vs once‐daily LAMA

The review found no eligible studies for this question.

• Once‐daily long‐acting beta₂‐agonists/inhaled corticosteroids combined inhalers versus inhaled long‐acting muscarinic… 2018 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found