The Addition of Salmeterol 50 µg Bid to Anticholinergenic Treatment in Patients with COPD: A Randomized Placebo Controlled Trial

Chapman, Kenneth R.; Arvidsson, Peter; Ag, Chuchalin; Dhillon, D P; Faurschou, P; Goldstein, Roger; Kuipers, AF

doi:10.1155/2002/493296

Cited by 54 publications

(37 citation statements)

References 24 publications

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“…Although LABAs reduced the use of rescue medication in the majority of studies, the efficacy of these agents on dyspnoea is not consistent across trials and significant benefits on exercise tolerance have not been well described (table 1) [9,[16][17][18][19][20][21][22][23][24][25][26][27][28][29]. However, a recent, small-scale (23 patients), mechanistic, crossover study showed that salmeterol significantly reduced hyperinflation, with consequent benefits in exertional dyspnoea and exercise tolerance [26].…”

Section: Long-acting B 2 -Agonistsmentioning

confidence: 99%

Impacting patient-centred outcomes in COPD: breathlessness and exercise tolerance

O’Donnell¹

2006

European Respiratory Review

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The physiological hallmark of chronic obstructive pulmonary disease (COPD) is expiratory flow limitation. However, it is the resultant air trapping and associated increases in lung volume (hyperinflation) that provide a mechanistic link between the physiological impairment and the characteristic symptoms of COPD, such as dyspnoea (breathlessness), exercise intolerance and reduced health-related quality of life (HRQoL).During exercise, the negative consequences of hyperinflation are particularly apparent. Delayed lung emptying and increased end-expiratory lung volume are aggravated, and tidal volume cannot rise to meet the increased ventilatory demands. Dyspnoea intensity rises abruptly to intolerable levels, and further increases in ventilation can only be achieved by rapid breathing. This rebounds to cause greater hyperinflation in a vicious cycle. As a result, patients with COPD often prematurely stop or avoid activity, leading to deconditioning, increased dyspnoea, worsening of disease and, ultimately, reduced HRQoL.The Global Initiative for Chronic Obstructive Lung Disease guidelines recommend long-acting bronchodilators as first-line maintenance treatment in COPD.Once-daily tiotropium 18 mg, a long-acting anticholinergic agent with 24-h efficacy, has been consistently shown to relieve dyspnoea and improve exercise tolerance and health status. These improvements may allow patients with chronic obstructive pulmonary disease to increase their daily activities, thereby reversing the cycle of chronic inactivity and muscle deconditioning.

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Section: Long-acting B 2 -Agonistsmentioning

confidence: 99%

Impacting patient-centred outcomes in COPD: breathlessness and exercise tolerance

O’Donnell¹

2006

European Respiratory Review

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“…Patients continued on ipratropium bromide 40 mg four times daily and were randomized to either salmeterol (50 mg twice daily) or placebo as add-on therapy. The investigators found evidence of significantly improved airflow in the salmeterol group compared with placebo at 4, 8, 16, and 24 weeks after the initiation of therapy (38). While the salmeterol group had fewer acute exacerbations of COPD (26% versus 33%), the results did not reach statistical significance (P 5 0.117).…”

Section: Long-acting B-agonists and Short-acting Anticholinergicsmentioning

confidence: 95%

“…The use of LABAs in combination with short-acting anticholinergics has been examined in several studies (37)(38)(39). van Noord and colleagues performed a 12-week multi-centered, randomized, double-blind trial in 144 patients with moderate-severe COPD (mean age 65; mean FEV 1 44% of predicted) (37).…”

Section: Long-acting B-agonists and Short-acting Anticholinergicsmentioning

confidence: 99%

“…Chapman and coworkers performed a double-blind, randomized, parallel group trial in 408 patients with COPD who were suboptimally controlled on ipratropium bromide (38). Patients continued on ipratropium bromide 40 mg four times daily and were randomized to either salmeterol (50 mg twice daily) or placebo as add-on therapy.…”

Section: Long-acting B-agonists and Short-acting Anticholinergicsmentioning

confidence: 99%

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Optimizing Bronchodilator Therapy in Emphysema

Diaz

Bruns²,

Ezzie³

et al. 2008

Proceedings of the American Thoracic Society

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The treatment objectives for chronic obstructive pulmonary disease (COPD) include relieving symptoms such as dyspnea and cough, slowing the accelerated decline in lung function, decreasing exacerbations, and improving quality of life. All major guidelines for COPD management recommend beginning treatment with bronchodilators. There are several classes of bronchodilators, including b-agonists, anticholinergics, and phosphodiesterase inhibitors, each with a specific mechanism of action. The overall approach to managing stable COPD involves a stepwise increase in treatment. Because of the progressive nature of emphysema, such an approach often involves combining bronchodilators from different pharmacologic classes. This review focuses on the pharmacologic properties of various bronchodilators and on recent studies that have examined combination therapy as a means to optimize treatment.

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“…However, recent meta-analyses have shown that tiotropium consistently reduced hospitalization rates in moderate-to-severe COPD (2,3). Pooled analyses, including such recent studies as TORCH (Towards a Revolution in COPD Health) (4), were conducted to update previous studies, and tiotropium is still the only inhaled therapy that consistently and significantly reduced hospitalizations (Forest plots are available at http://pulmccm.blogspot.com) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Although the TORCH study showed a statistically significant reduction in hospitalizations with combined LABA and inhaled corticosteroid therapy, not enough data are available to conduct a pooled analysis on COPD-related hospitalizations.…”

Section: Does Tiotropium Reduce Hospitalizations In Chronic Obstructimentioning

confidence: 99%

Are Pay-for-Performance Programs a Threat to Medical Professionalism?

Neubauer

Snyder

2008

Ann Intern Med

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TO THE EDITOR:We would like to congratulate Fuccio and colleagues (1) on their well-performed meta-analysis comparing different durations of triple therapy for Helicobacter pylori infection. However, we disagree with their conclusion that prolonging treatment is unlikely to be a clinically useful strategy. In our opinion, this statement is not supported by their results. The authors confirm previous findings (2, 3) that extending duration of treatment from 7 days to 10 or 14 days improves eradication rates, although the improvements in eradication rates (4% for 10 days and 5% for 14 days) were slightly lower than those previously reported (3% for 7 days, 8% for 10 days, and 12% for 14 days) (2, 3). They also found that extending treatment from 7 to 10 days increases efficacy in patients with nonulcer dyspepsia (relative risk difference, 11%) but not in patients with ulcer (relative risk difference, 2%) (4).We disagree with the conclusion for 3 reasons. First, it is based on a subanalysis of only 4 studies with high Jadad scale scores (5) that did not find statistically significant differences. Any subanalysis limited to 4 studies is likely to give negative results because of the small sample size and the consequent type II error; it cannot be used to argue for the lack of an effect. Second, their results show that the increase in eradication rates depends on the proportion of patients with nonulcer dyspepsia included in the meta-analysis. Therefore, the inclusion of 2 large studies dealing exclusively with patients with ulcer could only have led to an underestimation of the benefit of prolonging treatment. In fact, as we currently treat more patients with nonulcer dyspepsia than patients with ulcer, the benefit of lengthening duration of treatment is likely to be greater in clinical practice than Fuccio and colleagues' study suggests. Finally, eradication rates with triple therapy seem to be decreasing, and second-and third-line therapies often achieve suboptimal results as well. In this scenario, even a 4% to 5% increase in eradication rates is probably worth the greater cost, especially because there is no increase in side effects.In conclusion, we believe that the correct inference from the meta-analysis is that prolonging H. pylori treatment statistically significantly increases eradication rates. Whether it represents a clinically useful strategy remains a matter of opinion until new evidence emerges. 2. Calvet X, Ducons J, Bujanda L, Bory F, Montserrat A, Gisbert JP. Hp Study Group of the Asociación Española de Gastroenterología. Seven versus ten days of rabeprazole triple therapy for Helicobacter pylori eradication: a multicenter randomized trial. Am J Gastroenterol. 2005;100:1696-701. [PMID: 16086704] 3. Ford A, Moayyedi P. How can the current strategies for Helicobacter pylori eradication therapy be improved? Can J Gastroenterol. 2003;17 Suppl B:36B-40B. [PMID: 12845349] 4. Zagari RM, Bianchi-Porro G, Fiocca R, Gasbarrini G, Roda E, Bazzoli F. Comparison of 1 and 2 weeks of omeprazole, amoxicilli...

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The Addition of Salmeterol 50 µg Bid to Anticholinergenic Treatment in Patients with COPD: A Randomized Placebo Controlled Trial

Cited by 54 publications

References 24 publications

Impacting patient-centred outcomes in COPD: breathlessness and exercise tolerance

Impacting patient-centred outcomes in COPD: breathlessness and exercise tolerance

Optimizing Bronchodilator Therapy in Emphysema

Are Pay-for-Performance Programs a Threat to Medical Professionalism?

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