Impact of the IMPACT Trial.

Abstract

The latest iteration of the Global initiative for chronic Obstructive Lung Disease (GOLD)1 guidelines emphasizes the use of long-acting muscarinic antagonist /long-acting beta2-agonist (LAMA/LABA) combination therapy as maintenance therapy before triple therapy (inhaled corticosteroid [ICS]/LABA/LAMA) for chronic obstructive pulmonary disease (COPD) patients in the GOLD Group D and before an ICS/LABA combination in Group C. The exception for this is perhaps for those patients who have known, pre-existing asthma or are considered to have an asthma/COPD overlap. This recommendation is predicated on evidence that LABA/LAMA combinations have been shown to improve lung function and reduce symptoms as well as reduce exacerbations for patients who have had 1 or more exacerbation per year2,3 in combination with the evidence that inhaled corticosteroids increase the risk of pneumonia in at least a subset of individuals with COPD.4,5 Indeed, there has been a renewed debate regarding the exact role for inhaled corticosteroids in COPD overall. In this issue of the Journal Club we review the pivotal study , “InforMing the Pathway of COPD Treatment (IMPACT), that compares single inhaler triple therapy (LABA/LAMA/ICS) versus the same ICS/LABA in combination versus with the same LABA/LAMA in combination. The major focus of this Journal Club is the IMPACT study and how it helps to inform us regarding the COPD patient population that may be best suited for use of inhaled steroids. I provide the abstracts from additional recent studies that provide additional food for thought on how we might further refine the role for inhaled corticosteroids in COPD patients. Note: Abstracts are presented in their original, published format and have not been edited to match JCOPDF style.