Treatment guidelines for people with moderate to very severe COPD call for the use of an inhaled long-acting bronchodilator to reduce the risk of exacerbations. However, the guidelines don't weigh in on whether a long-acting anticholinergic or a long-acting beta2 agonist (LABA) is more effective at doing so. Findings from a recent study suggest that an anticholinergic may be the better choice.
Researchers randomly assigned 7,376 patients with moderate to very severe COPD and a history of exacerbations in the preceding year to treatment with the anticholinergic tiotropium (Spiriva), 18 mcg once daily or, with the LABA salmeterol (Serevent), 50 mcg twice daily. The researchers found that Spiriva increased the time to first severe exacerbation relative to Serevent, 187 days versus 145 days, respectively.
In addition, Spiriva users were 17 percent less likely to experience a flare-up. The incidence of serious adverse events and events leading to the discontinuation of therapy were similar in both groups.
Source: New England Journal of Medicine Volume 364, page 1093; March 2011