Guidelines recommend combination therapy of long-acting bronchodilators in moderate to severe COPD.
Baseline and Transition Dyspnea Indices (BDI and TDI) were assessed at the end of 6-week treatment periods in a 4-way, double-blind, crossover study of Tio 18 mcg (qd), Salm 50 mcg (bid), T (qd) + S (qd) or T (qd) + S (bid). In addition, bronchodilator-mediated symptom benefit was evaluated by the need for reliever medication (puffs of salbutamol during last 3 weeks of each period).
Mean screening FEV1 of the study population (N=97; 77 m/20 f, aged 65 yrs) was 1.09 L (39 % pred). The BDI was 6.9. A TDI (focal score) ≥ 1 unit is considered clinically relevant.
This is the first study with crossover design using BDI/TDI to assess dyspnea. Combination therapy was superior to single agent therapies in perceived dyspnea; no difference was found between once- or twice-daily Salm add-on therapy to Tio. Symptom benefit of combination regimens over the single agents was also reflected in less need for reliever medication.
In conclusion, combination therapy of T+S provided superior and clinically relevant improvement in dyspnea and less need for reliever medication compared to single agent therapies in moderate to severe COPD.
JA Van Noord, Grant monies (from industry related sources) First three authors received honorarium to conduct clinical research.