In Patients With COPD, Treatment With a Combination of Formoterol and Ipratropium Is More Effective Than a Combination of Salbutamol and Ipratropium

D’Urzo, Anthony; Salvo, María Cristina De; Ramírez-Rivera, Alicia; Almeida, João; Sichletidis, Lazaros; Rapatz, G.; Kottakis, John

doi:10.1378/chest.119.5.1347

Cited by 101 publications

(57 citation statements)

References 26 publications

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“…In some studies, long-acting b-agonists (LABAs) reduce exacerbation frequency, although this has been found in post hoc analyses. Both LABAs appear to have comparable efficacy, but no controlled comparative trials have been published so far, although LABAs have an add-on effect to short-acting anticholinergics [26]. Tolerance in the long-term use of LABAs does not appear to be a problem in clinical practice.…”

Section: Long-acting Bronchodilatorsmentioning

confidence: 99%

COPD: current therapeutic interventions and future approaches

Barnes¹

2005

European Respiratory Journal

232

143

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Although long-acting bronchodilators have been an important advance for the management of chronic obstructive pulmonary disease (COPD), these drugs do not deal with the underlying inflammatory process. No currently available treatments reduce the progression of COPD or suppress the inflammation in small airways and lung parenchyma. Several new treatments that target the inflammatory process are now in clinical development. Some therapies, such as chemokine antagonists, are directed against the influx of inflammatory cells into the airways and lung parenchyma that occurs in COPD, whereas others target inflammatory cytokines such as tumour necrosis factor-a.Broad spectrum anti-inflammatory drugs are now in phase III development for COPD, and include phosphodiesterase-4 inhibitors. Other drugs that inhibit cell signalling include inhibitors of p38 mitogen-activated protein kinase, nuclear factor-kB and phosphoinositide-3 kinase-c. More specific approaches are to give antioxidants, inhibitors of inducible nitric oxide synthase and leukotriene B 4 antagonists. Other treatments have the potential to combat mucus hypersecretion, and there is also a search for serine proteinase and matrix metalloproteinase inhibitors to prevent lung destruction and the development of emphysema.More research is needed to understand the cellular and molecular mechanisms of chronic obstructive pulmonary disease and to develop biomarkers and monitoring techniques to aid the development of new therapies.

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Section: Long-acting Bronchodilatorsmentioning

confidence: 99%

COPD: current therapeutic interventions and future approaches

Barnes¹

2005

European Respiratory Journal

232

143

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“…Combination treatment with formoterol plus ipratropium provides better improvement of pulmonary function and a greater reduction in symptoms [103]; similarly, combination treatment with salmeterol plus theophylline provides significantly greater improvements in pulmonary function, significantly greater reductions in symptoms, dyspnoea, and albuterol use, and significantly fewer COPD exacerbations [104]. Taken together, these two studies suggest that combination therapy with long-acting bronchodilators with different mechanisms of action may, in fact, produce additive effects.…”

Section: Introductionmentioning

confidence: 89%

The pharmacoepidemiology of COPD: Recent advances and methodological discussion

Burney¹,

Suissa

Soriano

et al. 2003

European Respiratory Journal

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“…However, VAN NOORD et al [33] showed that 12 weeks maintenance treatment with the combination of the LABA salmeterol and the SAAC ipratropium bromide was superior to salmeterol alone in terms of lung function and the incidence of exacerbations. Also, in patients requiring a combination of bronchodilators, the addition of the LABA formoterol to regular treatment with the SAAC ipratropium bromide was shown to be more effective in improving lung function and symptoms than the addition of the SABA salbutamol to the SAAC ipratropium bromide [34]. At that time point, optimal maintenance bronchodilator treatment in COPD appeared to be the combination of the SAAC ipratropium bromide and a LABA.…”

Section: Comparing Labas To the Saac Ipratropium Bromide In Copdmentioning

confidence: 97%

Bronchodilator treatment of stable COPD: long-acting anticholinergics

Vincken¹

2005

European Respiratory Review

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Since airflow obstruction in chronic obstructive pulmonary disease (COPD) is to some extent reversible, bronchodilators play an important role in the maintenance treatment of COPD the more they reduce hyperinflation and, as a result, improve dyspnoea and exercise capacity. Since parasympathetic activity is the dominant reversible component of airflow obstruction in COPD, inhaled short-acting anticholinergic agents (SAAC), in particular ipratropium, became an efficient and safe first-line treatment, especially when combined with a short-acting b 2 -adrenergic receptor agonist. Even better results were obtained when combining the SAAC ipratropium to a long-acting b 2 -adrenergic receptor agonist (LABA), once they became available.Recently, tiotropium bromide, the first of a new class of selective and long-acting anticholinergic agents was introduced for once-daily maintenance treatment of COPD patients. Several large long-term randomised clinical trials comparing tiotropium to placebo as well as to the SAAC ipratropium and the LABA salmeterol, have confirmed the long-acting and superior bronchodilator effect of tiotropium without any evidence of drug tolerance developing. These studies also have clearly demonstrated that tiotropium positively affects several other important health outcomes, such as dyspnoea sensation, exercise capacity, utilisation of rescue bronchodilators, health-related quality of life, COPD exacerbations and hospitalisations because of exacerbations. The improvement in these real-life outcomes appears related to the reduction in both static and dynamic hyperinflation. In all these studies, tiotropium was well tolerated and safe; the only relevant side-effect encountered being dry mouth, usually mild and often transitory. Finally, it has been shown that the combination of tiotropium with a LABA affords superior bronchodilatation than both agents alone, indicating that both classes of longacting bronchodilators should be regarded as complements rather than opponents.In conclusion, a sufficiently large and convincing database now exists to propose the once-daily long-acting anticholinergic tiotropium as first-line maintenance treatment for all chronic obstructive pulmonary disease patients in global initiative for chronic obstructive lung disease (GOLD)-class II and above, with a step-up to its combination with a long-acting b 2 -adrenergic receptor agonist in case of suboptimal clinical effect.

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In Patients With COPD, Treatment With a Combination of Formoterol and Ipratropium Is More Effective Than a Combination of Salbutamol and Ipratropium

Abstract: In COPD patients requiring combination bronchodilator treatment, the addition of formoterol to regular ipratropium treatment is more effective than the addition of salbutamol.

Cited by 101 publications

References 26 publications

COPD: current therapeutic interventions and future approaches

COPD: current therapeutic interventions and future approaches

The pharmacoepidemiology of COPD: Recent advances and methodological discussion

Bronchodilator treatment of stable COPD: long-acting anticholinergics

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