Recommended mono- or combination therapy of long-acting bronchodilators in COPD is successful if relief of dyspnea is provided.
A retrospective analysis was conducted in 93 patients (FEV1: 1.09 L / 39% pred) who completed a 4-way, double-blind, crossover study of tiotropium 18 mcg (qd), salmeterol 50 mcg (bid), T (qd) + S (qd) or T (qd) + S (bid). Patients were characterized as responder (R, > 12% increase in FEV1 45 min after 400 mcg salbutamol) or poor responder (PR, ≤ 12%) on the basis of a single test. Effects on dyspnea (TDI, ≥ 1 unit is clinically relevant), FEV1, FVC and need for reliever medication were compared at the end of 6-week treatment periods.
Mean FEV1 at screening was 1.05 L (37% pred, N = 57) in the R-group and 1.16 L (40% pred, N = 36) in the PR group.
Treatment responses showed the same rank order in the R and PR groups, with combination therapies superior to single agent therapy.
Data confirm guidelines regarding patient benefit of combination therapy of long-acting agents tiotropium plus salmeterol over mono-therapy in moderate to severe COPD, even in patients who fail to reach a pre-defined threshold response to salbutamol.
Mean*Tio (qd)Salm (bid)T(qd) + S(qd)T(qd) + S(bid)RPRRPRRPRRPRTDI (focal score)1.520.651.180.672.97#>1.93#>3.15#>2.08#FEV1 (0-12h) - ml142869732250152262164FVC (0-12h) - ml23018513366411301407294Puffs salb (0-12h)1.552.261.472.211.001.501.121.38*
Means are adjusted for centre, patient within centre and period.
JA van Noord, Grant monies (from industry related sources) First three authors received honorarium to conduct clinical research