In ISOLDE, fluticasone propionate significantly reduced the rate of exacerbations and slowed the rate of decline of health-related quality of life ( 87 – 89 ) and a post hoc analysis of the study showed a nonsignificant trend towards improved survival in patients from the fluticasone propionate arm ( P = 0.069) ( 90 ).
Calverley and colleagues plausibly suggest the study failed to reach statistical significance because it may have been underpowered ( 93 ).
More importantly, the TORCH study also supported the safety of LABAs in individuals with COPD, and showed a trend towards increased survival for patients treated with salmeterol alone compared with placebo (hazard ratio 0.879, 95% CI 0.729–1.061) and no increase in adverse events ( 93 ).