title: In patients with COPD, treatment with a combination of formoterol and ipratropium is more effective than a combination of salbutamol and ipratropium : a 3-week, randomized, double-blind, within-patient, multicenter study.
abstract: OBJECTIVE
  To compare the efficacy of adding formoterol or salbutamol to regular ipratropium bromide treatment in COPD patients whose conditions were suboptimally controlled with ipratropium bromide alone.
  
  
  METHODS
  A randomized, double-blind, double-dummy, two-period, crossover clinical trial.
  
  
  METHODS
  Twenty-four clinics and university medical centers in nine countries.
  
  
  METHODS
  One hundred seventy-two patients with baseline FEV(1) < or = 65% predicted, with FEV(1) reversibility to salbutamol not exceeding the normal variability of the measurement, and symptomatic despite regular treatment with ipratropium bromide.
  
  
  METHODS
  Each patient received two treatments in random order: either inhaled formoterol dry powder, 12 microg bid, in addition to ipratropium bromide, 40 microg qid for 3 weeks, followed by salbutamol, 200 microg qid, in addition to ipratropium, 40 microg qid for 3 weeks, or vice versa.
  
  
  RESULTS
  Efficacy end points included morning premedication peak expiratory flow (PEF) during the last week of treatment (primary end point), the area under the curve (AUC) for FEV(1) measured for 6 h after morning dose on the last day of treatment, and symptom scores (from daily diary recordings). Morning PEF and the AUC for FEV(1) were significantly better for formoterol/ipratropium than for salbutamol/ipratropium (p = 0.0003 and p < 0.0001, respectively). The formoterol/ipratropium combination also induced a greater improvement in mean total symptom scores (p = 0.0042). The safety profile of the two treatments was comparable.
  
  
  CONCLUSIONS
  In COPD patients requiring combination bronchodilator treatment, the addition of formoterol to regular ipratropium treatment is more effective than the addition of salbutamol.
authors.affiliation: Novartis Pharmaceuticals, Horsham, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: D'Urzo
authors.forename: M C
authors.initials: MC
authors.lastname: De Salvo
authors.forename: A
authors.initials: A
authors.lastname: Ramirez-Rivera
authors.forename: J
authors.initials: J
authors.lastname: Almeida
authors.forename: L
authors.initials: L
authors.lastname: Sichletidis
authors.forename: G
authors.initials: G
authors.lastname: Rapatz
authors.forename: J
authors.initials: J
authors.lastname: Kottakis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D005541:Forced Expiratory Volume; D000068759:Formoterol Fumarate; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage*; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D014797:Vital Capacity
chemical_list: D001993:Bronchodilator Agents; D004983:Ethanolamines; D009241:Ipratropium; D000420:Albuterol; D000068759:Formoterol Fumarate