The survival of patients with COPD is improving, albeit slowly, as a result of a series of modest enhancements in our management. In this issue of CHEST (see page 1104), Rodrigo and Neffen1 remind us of the latest of these incremental steps—the introduction of indacaterol, the first of the once-daily long-acting β2 agonists (LABAs) for the treatment of COPD.
Rodrigo and Neffen1 have reviewed the properties of indacaterol, contrasting it with currently available agents. Their thoughtful review suggests that indacaterol is not only an effective once-daily bronchodilator, but also may be more effective in clinical terms than once-daily tiotropium or bid LABAs such as formoterol and salmeterol. What is the likely impact of indacaterol’s availability in our management of COPD? Some might regard a once-daily LABA as a convenience to patients who might achieve a similar outcome with a bid LABA taken regularly. However, the data analyzed by Rodrigo and Neffen1 suggest that the sustained bronchodilator effect of indacaterol produces not only greater spirometric benefit than bid LABAs such as formoterol, but also differences accompanied by better patient-reported outcomes such as dyspnea and health status scores. Moreover, we suspect that compliance with a once-daily agent will be better than compliance with a bid agent, an issue better assessed in the real world than in the double-blind environment of phase 3 drug development.