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Review suggests asthma drugs safe, effective in COPD

NEW YORK (Reuters Health) - Previous research has linked a class of asthma drugs known as long-acting beta agonists to increased risk of adverse respiratory-related events or death in patients with COPD (chronic obstructive pulmonary disease).

However, a report published this month indicates this may not be the case.

The new report suggests that long-acting beta agonists have beneficial effects in patients with moderate-to-severe COPD and do not appear to increase the risk of respiratory deaths. Examples of long-acting beta agonists used to treat asthma and other respiratory conditions include Advair, Serevent, Foradil and Symbicort.

In the study, Dr. Gustavo J. Rodrigo, from Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay and colleagues pooled data from 27 randomized clinical trials that compared two long-acting beta agonists with placebo or with two long-acting “anticholinergic” asthma drugs (for example, Spiriva) in patients with moderate to severe COPD.

Compared with placebo, long-acting beta agonist therapy reduced severe COPD flare-ups by 21 percent and did not increase death from COPD.

Treatment with a long-acting beta agonist had benefits “in terms of lung function, quality of life, and use of daily rescue medication” with short-acting beta agonists, Rodrigo noted in comments to Reuters Health.

However, in an editorial published with the study in the journal Chest, Dr. Malcolm R. Sears from McMaster University, Hamilton, Ontario, Canada, urges caution in applying this finding to the real world. “In COPD trials, patients are carefully selected and monitored, and asthma is generally excluded. In real life, asthma and COPD can be hard to disentangle especially in older patients,” he writes.

Hence, accepting the current results that a long-acting beta agonist alone is appropriate and safe in patients with COPD “may put some patients who in fact have asthma at risk if treated in this manner,” Sears warns.

Rodrigo’s team also found that treatment with a long-acting beta agonist combined with an inhaled steroid was associated with lower respiratory death compared with a long-acting beta agonist alone.

“Given the reduced mortality with the use of inhaled corticosteroids in combination with long-acting beta-2 agonist therapy, one would argue that, in COPD, concomitant inhaled corticosteroid therapy is preferable to long-acting beta-2 agonist monotherapy,” Rodrigo told Reuters Health.

The pooled data also showed that treatment with Spiriva decreased the incidence of severe COPD flare-ups compared with a long-acting beta agonist.

Commenting on this finding, Sears writes: “Overall, daily tiotropium (Spiriva) appears to be foundational as a long-acting bronchodilator in COPD, despite some equivocation on this matter in current COPD treatment guidelines.”

SOURCE: Chest, May 2008.