OBJECTIVES: Recent studies have suggested that use of inhaled corticosteroids (ICS) may improve survival in COPD, particularly when combined with a long-acting beta agonist (LABA). However, the methods used to conduct these retrospective studies have been questioned and none have examined what effect the newer combination ICS/LABA inhalers may have on survival. The goal of this project was to further examine the relationship between ICS treatment, with or without LABA, and survival in COPD. METHODS: COPD patients were identified from the administrative databases of four different managed care programs: Lovelace Health Plan (Albuquerque NM), Health Partners Health System (Minneapolis/St Paul MN), Henry Ford Health System's Alliance Plan (Detroit MI), and Harvard Pilgrim Health Care (Boston MA). All patients who were diagnosed with COPD between September 1, 2000 and August 31, 2001 and who had at least 3 months treatment with either fluticasone/salmeterol (ADVAIR, N=866), some other ICS/LABA (N=525), ICS alone (N=742), LABA alone (N=531), or a short-acting bronchodilator alone (SABD, N=1832), were included. RESULTS: In the basic Cox proportional hazards models, use of ADVAIR, ICS/LABA, and ICS alone had significant survival benefits as compared to SABD alone, after adjustment for differences in age, gender, comorbidities, asthma status, and disease severity (HRs 0.638, 0.603, and 0.784, respectively, p<0.05). Propensity score matching to reduce the clinical differences between the treatment groups versus the SABD reference groups found very similar results. Nested case-control matching based on survival status continued to show a highly significant survival benefit for ADVAIR; other treatments also had favorable RR that did not reach statistical significance. CONCLUSIONS: Treatment with ADVAIR or another ICS with or without LABA is associated with improved survival in COPD. The treatment benefit seen with ADVAIR is robust to a number of analyses designed to adjust for differences in clinical parameters and bias by indication.