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Long-acting beta2-agonists for poorly reversible chronic obstructive pulmonary disease
1Queen Elizabeth Hospital, Dept. of Medicine, Woodville Rd., Woodville, Adelaide, Australia 5011. sappleto@medicine.adelaide.edu au
The Cochrane Database of Systematic Reviews
|July 21, 2006
Summary
Long-acting beta-agonists (LABAs) like salmeterol offer modest lung function improvements for COPD patients with poor bronchodilator reversibility. Salmeterol 50 mcg BID consistently reduced exacerbations, a key benefit for frequent symptom deteriorations.
Area of Science:
- Pulmonology
- Pharmacology
- Clinical Trials
Background:
- Chronic obstructive pulmonary disease (COPD) involves airflow limitation with variable reversibility.
- Many COPD patients show limited response to short-acting bronchodilators.
- Long-acting bronchodilators are often recommended despite limited reversibility data.
Purpose of the Study:
- To assess the efficacy of long-acting beta-2 adrenoceptor agonists (LABAs) in COPD patients with poor short-acting bronchodilator reversibility.
- Evaluate LABA effectiveness in improving lung function and reducing exacerbations.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) comparing inhaled LABAs (salmeterol, formoterol) with placebo.
- Included studies were a minimum of four weeks in duration for stable COPD patients.
- Data extraction and quality assessment were performed independently by two authors.
Main Results:
- Salmeterol 50 mcg twice daily (BID) significantly improved forced expiratory volume in 1 second (FEV1) by 51 ml and peak expiratory flow (PEF).
- Reduced use of supplemental short-acting bronchodilators and improved St. George's Respiratory Questionnaire scores were observed with salmeterol.
- A significant reduction in exacerbations was noted (number needed to treat: 21), but exercise tolerance showed no significant difference.
Conclusions:
- Salmeterol 50 mcg BID provides modest lung function improvements in COPD patients with poor reversibility.
- Consistent reduction in exacerbations is a significant benefit for patients experiencing frequent symptom deterioration.
- Evidence for other LABA dosages or formoterol was insufficient to guide clinical practice.
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