WEDNESDAY, March 23 (HealthDay News) -- People with
moderate-to-severe chronic obstructive pulmonary disease (COPD) use
inhaled long-acting bronchodilators to control symptoms and reduce
flare-ups, but which type of drug is best hasn't been clear.
Now results have arrived from a new study that pitted two
different popular COPD drugs against each other to determine their
effectiveness at controlling the disease, which interferes with the
flow of air through the lungs and airways. One of the drugs was
tiotropium (Spiriva), an anticholinergic, and the other was
salmeterol (Serevent), a beta-agonist.
The outcome of the trial suggests that Spiriva is more effective
at preventing flare-ups, also called exacerbations.
"Prevention of exacerbations is a critical treatment goal in the care of COPD patients due to the [illness and death] attributed to exacerbations," said lead study author Dr. Claus Vogelmeier, who is from the pulmonary diseases division at University Hospital Marburg in Germany.
"The results of this trial provide data on which to base the choice of long-acting bronchodilator therapy," he added.
The report is published in the March 24 issue of the
New England Journal of Medicine.
For the trial, in which neither the patients nor investigators
knew which medications were assigned to the participants,
Vogelmeier's group randomly assigned 7,376 patients with
moderate-to-severe COPD to one of the two drugs.
During the one-year study, participants took either 18
micrograms (mcg) of Spiriva once daily or 50 mcg of Serevent twice
daily. The researchers found patients using Spiriva had a lower
risk of flare-ups than those using Serevent. In fact, Spiriva users
reduced their risk of a first incident by 17 percent.
Spiriva also cut the number of severe flare-ups in a year and
reduced the number of moderate-to-severe flare-ups compared with
Serevent. However, the incidence of serious adverse events and
events leading to the discontinuation of therapy were similar in
both study groups, the researchers noted. Adverse events included
worsening of disease, infections, heart problems, other
complications or death.
For patients with mild COPD, both drugs appear equally
effective, the study authors noted.
"These data suggest that, in patients with moderate-to-very severe COPD and a history of exacerbations, tiotropium [Spiriva] should be considered first choice over salmeterol [Serevent] as maintenance treatment," Vogelmeier said.
Why one medication is better than the other at reducing
flare-ups isn't clear, said senior study author Dr. Leonardo
Fabbri, a professor of respiratory medicine at the University of
Modena and Reggio Emilia in Modena, Italy.
There is a place for both drugs and even using both together,
Fabbri noted. "Guidelines recommend the use of both medications
when one is deemed not to be adequately effective," he said. "But
this recommendation is based on little evidence. Usually, we have
to add an inhaled steroid instead of another bronchodilator."
Fabbri also pointed out that neither drug cures COPD or slows
its progression. "These are purely drugs [that treat symptoms]," he
The study was funded by Boehringer Ingelheim and Pfizer, the
makers of Spiriva. Spiriva can cost over $200 a month. Serevent,
made by GlaxoSmithKline, can cost over $100 a month, depending on
the dose and how the medication is delivered.
Dr. Jadwiga A. Wedzicha, a professor of respiratory medicine at
University College London Medical School of University College
London in the United Kingdom and author of an accompanying journal
editorial, said that a bronchodilator "is really just the start of
Many COPD patients will need both anticholinergics and
beta-agonists, as well as an inhaled corticosteroid. In addition,
new drugs are being developed so there will be more choices in the
future, Wedzicha said.
"COPD is treatable," Wedzicha added. "We know outcomes can be improved."
Commenting on the study, Dr. Len Horovitz, a pulmonary
specialist at Lenox Hill Hospital in New York City, said that "in
COPD there is a paucity of medications, and because one works to
prevent exacerbations doesn't mean you eliminate your other
Horovitz said COPD patients who are well controlled are taking
several drugs. "I don't want anyone to take away from this study
that we don't need anything but tiotropium. That's just not so," he
COPD, which generally consists of chronic bronchitis or
emphysema, is a progressive disease that causes increasing damage
to the lungs, making breathing difficult. Most COPD is caused by
chronic exposure to lung irritants such as cigarette smoke, but it
can also be caused by long-term exposure to other environmental
For more information on COPD, visit the
U.S. National Heart, Lung, and Blood
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