New treatment options in COPD.

OBJECTIVE: To review the role of long-acting bronchodilators in the treatment of chronic obstructive pulmonary disease (COPD), including the importance of treatment adherence. SUMMARY: Overall, clinical trials show that compared with placebo and ipratropium, tiotropium significantly improves spirometric measures, increases quality-of-life scores, and is associated with fewer exacerbations. In addition, compared with salmeterol, tiotropium is associated with greater improvements in spirometric measures and clinically meaningful increases in quality-of-life measures. In comparison with either fluticasone or salmeterol alone, the fluticasone/salmeterol combination is associated with statistically greater improvement in spirometric and dyspnea measures; however, the combination is not associated with fewer exacerbations than either fluticasone or salmeterol used by itself. CONCLUSIONS: The 2003 update to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommends regular treatment with long-acting bronchodilators for maintenance COPD therapy because of superior effectiveness and convenience compared with short-acting bronchodilators. The results from trials presented in this article demonstrate that inhaled tiotropium is effective in treating COPD and might be considered as a first-line agent for maintenance therapy in view of its outcomes data. The convenience of once-daily administration would probably contribute to patient adherence and thus to the overall efficacy of this agent.