New findings may alter the treatment guidelines of COPD. The drug tiotropium has been found to be more effective than salmeterol in preventing exacerbations.
Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases that make it difficult to breathe. It is a leading cause of disability and death worldwide. The more a person smokes, the more likely that person will develop COPD. There is no complete cure for COPD. All that can be done is to relieve symptoms and keep the disease from getting worse. The best way to slow down lung damage is to stop smoking.
AdvertisementThe prevention of exacerbations constitutes a major goal of treatment. Exacerbations of COPD indicate instability or worsening of the patient's clinical status and progression of the disease. Exacerbations are associated with the development of complications, an increased risk of subsequent exacerbations, reduced health status and physical activity, deterioration of lung function, and an increased risk of death.
Medications used include:
• Inhalers (bronchodilators) to open the airways, such as ipratropium, tiotropium, salmeterol, or formoterol
• Inhaled steroids to reduce lung inflammation
Tiotropium belongs to a group of drugs called anticholinergics. These work by blocking specific neurotransmitters in the nervous system. Salmeterol is a â2-agonist, i.e. part of the class of drugs that relaxes smooth muscles. Both of these drugs reduce symptoms, improve quality of life and lung function, and reduce the risk of exacerbations and hospitalizations. Therapy with a long-acting anticholinergic drug or a long-acting â2-agonist is recommended as first-line maintenance therapy in patients with moderate-to-very-severe COPD.
A recent study compared both. Researchers investigated whether the anticholinergic drug tiotropium is superior to the â2-agonist salmeterol in preventing exacerbations of COPD. The study was performed at 725 centers in 25 countries to compare the effect of tiotropium with that of salmeterol. A total of 7384 patients were involved.
The one year long trial concluded that tiotropium was more effective. 'In patients with moderate-to-very-severe COPD, tiotropium is more effective than salmeterol in preventing exacerbations', writes authors. Results were published in the New England Journal of Medicine (NEJM), the leading medical journal. Time to first exacerbation was significantly longer with tiotropium.
None of the treatment guidelines specify whether a long-acting anticholinergic drug or a â2-agonist is the preferred agent. The new study results would bring a change to this.
Source: Tiotropium versus Salmeterol for the Prevention of Exacerbations of COPD. Claus Vogelmeier, M.D., Bettina Hederer, M.D., Thomas Glaab, M.D., Hendrik Schmidt, Ph.D., Maureen P.M.H. Rutten-van Mölken, Ph.D., Kai M. Beeh, M.D., Klaus F. Rabe, M.D., and Leonardo M. Fabbri, M.D. for the POET-COPD Investigators. N Engl J Med 2011; 364:1093-1103; March 24, 2011.