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Combinations of Long-Acting Inhaled Agents for COPD

Adding formoterol to tiotropium yielded significant additional improvements.

ß-agonist and anticholinergic agents reduce symptoms in patients with chronic obstructive pulmonary disease (COPD). In this randomized, placebo-controlled, crossover study, European researchers examined the effect on lung function of combining the long-acting inhaled ß-agonist formoterol and the long-acting inhaled anticholinergic tiotropium (Spiriva). The study was funded by the maker of tiotropium.

Each of 95 patients with COPD received 2-week courses of tiotropium alone (once daily in the morning), tiotropium plus formoterol (both once daily in the morning), and tiotropium once daily plus formoterol twice daily. At baseline and at the end of each 2-week period, pulmonary function was measured repeatedly during a 24-hour period.

Mean forced vital capacity, FEV₁, and inspiratory capacity increased from baseline levels with tiotropium alone. When once-daily formoterol was added to tiotropium, significant additional improvements in these measures were noted, mostly during the daytime. When formoterol was given twice daily, patients experienced additional incremental benefit overnight.

Comment: This study demonstrates that combined therapy with two long-acting bronchodilators confers a short-term improvement in pulmonary function in patients with COPD; once-daily or twice-daily formoterol, added to tiotropium, were both better than tiotropium alone. Two remaining questions are whether these changes in pulmonary function are sustained during long-term treatment, and whether they translate into improved symptoms.

— Allan S. Brett, MD

Published in Journal Watch General Medicine April 4, 2006

Citation(s):

van Noord JA et al. Effects of tiotropium with and without formoterol on airflow obstruction and resting hyperinflation in patients with COPD. Chest 2006 Mar; 129:509-17.

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