New treatment options in COPD.
OBJECTIVE
To review the role of long-acting bronchodilators in the treatment of chronic obstructive pulmonary disease (COPD), including the importance of treatment adherence.


CONCLUSIONS
Overall, clinical trials show that compared with placebo and ipratropium, tiotropium significantly improves spirometric measures, increases quality-of-life scores, and is associated with fewer exacerbations. In addition, compared with salmeterol, tiotropium is associated with greater improvements in spirometric measures and clinically meaningful increases in quality-of-life measures. In comparison with either fluticasone or salmeterol alone, the fluticasone/salmeterol combination is associated with statistically greater improvement in spirometric and dyspnea measures; however, the combination is not associated with fewer exacerbations than either fluticasone or salmeterol used by itself.


CONCLUSIONS
The 2003 update to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommends regular treatment with long-acting bronchodilators for maintenance COPD therapy because of superior effectiveness and convenience compared with short-acting bronchodilators. The results from trials presented in this article demonstrate that inhaled tiotropium is effective in treating COPD and might be considered as a first-line agent for maintenance therapy in view of its outcomes data. The convenience of once-daily administration would probably contribute to patient adherence and thus to the overall efficacy of this agent.
Creighton University School of Pharmacy, 2500 California St., Omaha, NE 68178, USA. hilleman@creighton.edu
Daniel E
DE
Hilleman
D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests
D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations