Use of a Long-acting Inhaled β₂-Adrenergic Agonist, Salmeterol Xinafoate, in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Chronic obstructive pulmonary disease (COPD) is a condition in which continuous bronchodilation may have clinical advantages. This study evaluated salmeterol, a beta-agonist bronchodilator with a duration of action substantially longer than that of short-acting beta-agonists, compared with ipratropium, an anticholinergic bronchodilator, and placebo in patients with COPD. Four hundred and five patients with COPD received either salmeterol 42 microg twice daily, ipratropium bromide 36 microg four times daily, or placebo for 12 wk in this randomized, double-blind, parallel-group study. Patients were stratified on the basis of bronchodilator response to albuterol (> 12% and > 200-ml improvement) and were randomized within each stratum. Bronchodilator response was measured over 12 h four times during the treatment period. Salmeterol provided similar maximal bronchodilatation to ipratropium but had a longer duration of action and a more constant bronchodilatory effect with no evidence of bronchodilator tolerance. Both active treatments were well tolerated. Salmeterol was an effective bronchodilator with a consistent effect over this 12-wk study in patients with COPD, including those "unresponsive" to albuterol. The long duration of action of salmeterol offers the advantage of twice daily dosing compared with the required four times a day dosing with ipratropium.

Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care

“…1,2 Nonetheless, it has been shown that the use of spirometry is limited with only a third of newly diagnosed individuals with COPD actually having spirometry to confirm the presence of irreversible air flow obstruction. [3][4][5] Although appropriate therapy with inhaled medications have been demonstrated to reduce symptoms, improve health-related quality of life, and decrease the rate of acute exacerbations [6][7][8][9][10][11][12][13][14][15][16][17][18][19] , there is growing evidence that pharmacotherapy used to treat patients for COPD pose risks. 6,7,[20][21][22][23][24][25] Without spirometry, patients who have been diagnosed with COPD may be being medically managed without evidence of airways obstruction, leading to unnecessary exposure to risks and costs associated with COPD therapy.…”

Evaluating the cost-effectiveness of tiotropium versus salmeterol in the treatment of chronic obstructive pulmonary disease

“…The characteristics of the hypothetical patients were selected to closely reflect the characteristics of the patient population included in the randomized clinical trials of the treatments. 15,18,19,22 Cycle length…”

“…The efficacy data for the no treatment group are the data obtained for placebo arms of clinical trials for tiotropium and salmeterol. 15,18,19,22 For tiotropium, 3 studies were identified. In a study by Casaburi and colleagues,18 the exacerbation rate per patient per year for tiotropium was 0.086.…”

“…These two medications have an advantage over other medications Cost-effectiveness of tiotropium vs salmeterol in COPD Dovepress submit your manuscript | www.dovepress.com Dovepress used in COPD in that they are long-acting and require less frequent administration than other drugs. [15][16][17][18][19] This study aims at developing a decision analytical model to measure the cost-effectiveness of 3 treatment strategies: tiotropium, salmeterol, and no treatment. A Markov model, a type of decision analytic model, was developed to compare the costs and effects of tiotropium, salmeterol, and no treatment.…”

Medical therapy for COPD: lessons from the real world

“…Although the very varied quality of community prevalence data have to be relied upon to draw these conclusions, the use of randomised controlled trials to evaluate the efficacy of treatment for COPD is more reliable. This approach has now yielded a large body of scientific data, which confirm that long-acting b-agonists (LABA) improve lung function and health status in stable COPD [3][4][5] whilst also increasing the time between exacerbations [4,6]. Likewise, largescale 3-yr randomised studies have failed to find any effect of inhaled corticosteroids on the rate of decline of the forced expiratory volume in one second (FEV1), but in more severe patients, these drugs reduce the number of exacerbations [7][8][9][10].…”