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29-03-2011 | General practice | Article

Anticholinergic: bronchodilator of choice


New Engl J Med 2011; 364: 1093–1103

The long-acting anticholinergic tiotropium appears to be superior to the β2-agonist salmeterol for preventing exacerbations in patients with moderate chronic obstructive pulmonary disease (COPD), study findings show.

The results go some way to answering the question as to whether a long-acting anticholinergic drug or β2-agonist should be the preferred agent when using inhaled long-acting bronchodilators, according to treatment guidelines, in patients with COPD.

The Prevention of Exacerbations with Tiotropium in COPD (POET-COPD) researchers, led by Leonardo Fabbri (University of Modena and Reggio Emilia, Italy), compared the effect of 1-year treatment with 18 µg of tiotropium once daily and 50 µg salmeterol twice daily on exacerbations in 7376 patients with COPD who had a FEV1 of 70% of the predicted value.

Tiotropium treatment prolonged the time to the first exacerbation by 42 days, compared with salmeterol, and significantly reduced the risk of an exacerbation by 17%.

Triotropium also outperformed salmeterol with regard to the time to first severe exacerbation, and in reducing the annual number of moderate and severe exacerbations.

The incidence of serious adverse events and deaths was similar between the two treatment groups.

Concomitant medications including inhaled glucortocoids were being taken by 50% of patients, but post hoc analyses indicated that this had no effect on the reduction of exacerbations by tiotropium.

"The results of this large trial provide data on which to base the choice of long-acting bronchodilator therapy for maintenance of COPD," concludes the team in the New England Journal of Medicine.

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Lucy Piper