The comparisons of the efficacy of two fixed dose combinations, i.e. Salmeterol and Fluticasone vs. Formoterol and Tiotropium bromide in moderate to severe COPD patients
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20182681Keywords:
COPD, FDC, LABA, ICS, Inhaled bronchodilators, TiotropiumAbstract
Background: Bronchodilators are essential for symptomatic management of all stages of chronic obstructive pulmonary disease (COPD). For patients whose COPD is not sufficiently controlled by monotherapy, combining a ß2-agonist with either inhaled steroid or anticholinergic drug is a convenient way of delivering treatment. Currently, there is no documentation to say that one drug is superior to other or the contrary, but a combination of two drugs is more effective than giving single drug alone in patients suffering from COPD.
Methods: The study was prospective, open labelled, randomized, comparative interventional clinical study conducted by the Departments of Pharmacology and Medicine, Basaveshwara Medical College and Hospital, Chitradurga in 60 moderates to severe COPD patients.
Results: Both the treatments i.e. Salmeterol/Fluticasone and Tiotropium/Formoterol were equally effective as far as the improvement of the lung functions and Borg dyspnoea score are concerned. The difference in improvement with the combination of Salmeterol/Fluticasone was not statistically significant (p>0.05) compared to the combination of Tiotropium/Formoterol. However, Salmeterol/Fluticasone was found to be better than Tiotropium/Formoterol in improving the lung function of moderate to severe COPD patients.
Conclusions: Salmeterol/Fluticasone is efficacious and better than Tiotropium /Formoterol combination for maintenance therapy in moderate to severe COPD patients.
References
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (Online); Updated 2017. Available at: http://www.goldcopd.com
Mannino DM. The natural history of chronic obstructive pulmonary disease. Pneumonol Alergol Pol. 2011;79:139-43.
Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006;27:397-412.
Pauwels RA, Buist AS, Calverley P, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163:1256-76.
Barnes PJ. Emerging pharmacotherapies for COPD. Chest. 2008;134:1278-86.
Calverley PM, Anderson JA, Celli B. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;22:775-89.
Mahler DA. The effect of inhaledbeta2-agonists on clinical outcomes inchronic obstructive pulmonary disease. J Allergy ClinImmunol. 2002;110:S298-303.
Calverley PM. Modern treatment of chronic obstructive pulmonary disease. Eur Respir J. 2001;18:60s-6s.
Sin DD, McAlister FA, Man SF, Anthonisen NR. Contemporary management of chronic obstructive pulmonary disease: scientific review. JAMA 2003;290:2301-12.
Rabe KF, Hurd S, Anzueto A. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-55.
Cazzola M, Dahl R. Inhaled combination therapy with long-acting beta2-agonists and corticosteroids in stable COPD. Chest. 2004;126:220-37.
Gross NJ. Chronic obstructive pulmonary disease: current concepts and therapeutic approaches. Chest 1990;97:19-23.
American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis. 1987;136:225-44.
Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142:233-9.
Celli BR, MacNee W. ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: A summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932-46.
Oostenbrink JB, Rutten-van Mölken MP, Al MJ, van Noord JA, Vincken W. One-year cost-effectiveness of tiotropium versus ipratropium to treat chronic obstructive pulmonary disease. Eur Respir J. 2004;23:241-9.
Wedzicha JA, Calverley PMA, Seemungal TA. The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/ fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med. 2008;177:19-26.
Akazawa M, Hayflinger DC, Stanford RH, Blanchette CM. Economic assessment of total health care for chronic obstructive pulmonary disease. Am J Manag Care. 2008;14:438-48.
Dalal AA, Petersen H, Simoni-Wastila L, Blanchette CM. Healthcare costs associated with initial maintenance therapy with fluticasone propionate 250 μg/salmeterol 50 μg combination versus anticholinergic bronchodilators in elderly US Medicare eligible beneficiaries with COPD. J Med Econ. 2009;12:339-47.
Delea TE, Hagiwara M, Dalal AA, Stanford RH, Blanchette CM. Healthcare use and costs in patients with chronic bronchitis initiating maintenance therapy with fluticasone/salmeterolvs other inhaled maintenance therapies. Curr Med Res Opin. 2009;25:1-13.
Welte T. Optimising treatment for COPD - new strategies for combination therapy. Int J Clin Pract. 2009;63:1136-49.
Guyatt GH, Townsend M, Pugsley SO, Keller JL, Short HD, Taylor DW, et al. Bronchodilators in chronic airflow limitation: effects on airway function, exercise capacity and quality of life. Am Rev Respir Dis. 1987;135:1069-74.
D’Urzo AD, De Salvo MC, Ramirez-Rivera A, Almeida J, Sichletidis L, Rapatz G, et al. In patients with COPD, treatment with a combination of formoterol and ipratropium is more effective than a combination of salbutamol and ipratropium: a 3- week, randomized, double-blind, within-patient, multicenter study. Chest. 2001;119:1347-56.
