Indacaterol. A long-acting beta-2 agonist, no advantages in COPD

In patients with chronic obstructive pulmonary disease (COPD), bronchodilator drugs have only modest symptomatic efficacy. There is no evidence that they slow disease progression. A short-acting beta-2 agonist such as salbutamol is the first-choice treatment, used either on demand or on a regular basis. Long-acting beta2 agonists are an option for patients with nocturnal symptoms. Indacaterol is a long-acting beta-2 agonist that is inhaled once a day. Indacaterol has not been compared with a short-acting beta-2 agonist. Clinical evaluation is based on 4 double-blind randomised placebo-controlled trials, 3 of which also included a group treated with another long-acting bronchodilator (formoterol, salmeterol or tiotropium. The symptomatic efficacy of indacaterol was only modest, and similar to that of other long-acting bronchodilators. Indacaterol has the known adverse effect profile of beta-2 agonists. Some adverse effects seem to be more frequent than with other long-acting bronchodilators, including post-inhalation cough, hyperglycaemia, respiratory tract infections, and possibly cardiac disorders. There is no evidence that once-daily inhalation has any advantages over twice-daily inhalation, even in terms of convenience. In addition, as efficacy is limited, there is a risk that patients will use the drug more frequently, resulting in additional adverse effects. The nebulizer used to inhale the powder in the capsules is similar to the one provided with Foradil (formoterol. In practice, indacaterol offers no therapeutic advantage over existing treatments for patients with COPD. It is better to use the best-documented drugs and, if necessary, to add non-drug measures. Eliminating exposure to toxic agents, especially tobacco smoke, remains the only treatment with a proven benefit on the course of COPD.