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
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.
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.
• 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
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.
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.
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
), the leading medical
journal. Time to first exacerbation was significantly longer with tiotropium.
the treatment guidelines specify whether a long-acting anticholinergic drug or
-agonist is the preferred agent. The new study results would
bring a change to this.
: 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.