This study shows that the risk of pneumonia and pneumonia related events are higher with
fluticasone/salmeterol than with budesonide/formoterol in patients with COPD. However, it
is important to note that the event rate was higher in the fluticasone/salmeterol group to start
with and this was not adjusted for in the analysis. Differences may be related to differences in
the immunosuppressant potency between budesonide and fluticasone. Long term randomised
controlled trials would be beneficial to assess the extent of such intraclass differences put in
context with the benefits of such regimens in preventing exacerbations.