Addition of salmeterol to existing treatment in patients with COPD: a 12 month study

Stockley, R A; Chopra, Narinder; Rice, Leanne

doi:10.1136/thx.2004.033266

Cited by 89 publications

(56 citation statements)

References 25 publications

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“…Previous studies have shown that the addition of the LABA salmeterol results in a decrease in the exacerbation rate, improved health status, an increase in forced expiratory volume in 1 s (FEV 1 ) and in a reduction of lung hyperinflation at rest and during exercise [13,14,15,16,17,18]. …”

Section: Introductionmentioning

confidence: 99%

Effects of Salmeterol on Sleeping Oxygen Saturation in Chronic Obstructive Pulmonary Disease

Ryan¹,

Doherty²,

Rock³

et al. 2009

Respiration

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Background: Sleep is associated with important adverse effects in patients with chronic obstructive pulmonary disease (COPD), such as disturbed sleep quality and gas exchange, including hypoxemia and hypercapnia. The effects of inhaled long-acting β₂-agonist therapy (LABA) on these disturbances are unclear. Objectives: The aim of the study was to assess the effect of inhaled salmeterol on nocturnal sleeping arterial oxygen saturation (SaO₂) and sleep quality. Methods: In a randomized, double-blind, placebo-controlled, crossover study of moderate/severe stable COPD patients, we compared the effects of 4 weeks of treatment with salmeterol 50 µg b.d. and matching placebo on sleeping SaO₂ and sleep quality. Overnight polysomnography (PSG) was performed at baseline, and after 4 and 8 weeks in addition to detailed pulmonary function testing. Of 15 patients included, 12 completed the trial (median age 69 years, forced expiratory volume in 1 s, FEV₁: 39%). Results: Both mean SaO₂ [salmeterol vs. placebo: 92.9% (91.2, 94.7) vs. 91.0% (88.9, 94.8); p = 0.016] and the percentage of sleep spent below 90% of SaO₂ [1.8% (0.0, 10.8) vs. 25.6% (0.5, 53.5); p = 0.005] improved significantly with salmeterol. Sleep quality was similar with both salmeterol and placebo on PSG. Static lung volumes, particularly trapped gas volume, tended to improve with salmeterol. Conclusion: We conclude that inhaled LABA therapy improves sleeping SaO₂ without significant change in sleep quality.

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Section: Introductionmentioning

confidence: 99%

Effects of Salmeterol on Sleeping Oxygen Saturation in Chronic Obstructive Pulmonary Disease

Ryan¹,

Doherty²,

Rock³

et al. 2009

Respiration

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“…Research suggests that this stabilization approach may have benefits for trials compared with withdrawing maintenance therapy during run-in. In particular, it may improve detection of clinically important changes in health status, and reduce the proportion of withdrawals during run-in (41)(42)(43).…”

Section: Discussionmentioning

confidence: 99%

Investigating New Standards for Prophylaxis in Reduction of Exacerbations—The INSPIRE Study Methodology

Seemungal

Stockley

Calverley

et al. 2007

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Bronchodilators, including long-acting beta(2)-adrenoceptor agonists and anticholinergic bronchodilators, are effective in the treatment of chronic obstructive pulmonary disease. Evidence suggests that the addition of a long-acting beta(2)-agonist to an inhaled corticosteroid is associated with a reduced rate of exacerbations compared with either treatment alone or placebo. However, it is not known whether a long-acting beta(2)-agonist/inhaled corticosteroid combination is more effective than an anticholinergic bronchodilator alone in reducing exacerbations. The Investigating New Standards for Prophylaxis In Reduction of Exacerbations (INSPIRE) trial will study salmeterol (a long-acting beta(2)-agonist) in combination with fluticasone propionate (an inhaled corticosteroid) compared with tiotropium bromide (an anticholinergic bronchodilator) in patients with moderate-to-severe chronic obstructive pulmonary disease. The INSPIRE study is a multicentre, randomised, double-blind, double dummy, parallel group study conducted over 104 weeks. This is the first study to use two parallel definitions of an exacerbation; an event-based exacerbation is defined as one that requires use of healthcare resources, including additional treatment and hospitalization, whereas a symptom-based exacerbation is defined as one that satisfies the 1987 Anthonisen criteria. It is also the first study to compare the long-term effects of salmeterol/fluticasone propionate with tiotropium bromide on the rate of event-based exacerbations. Endpoints include rate of exacerbations (primary endpoint), time to first exacerbation, and duration of exacerbations. Health outcomes will be assessed via the St George's Respiratory Questionnaire. If the innovative methodology of utilizing 2 definitions of exacerbation proves successful, it will set the benchmark for future studies in chronic obstructive pulmonary disease.

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“…Reliance on ''as needed'' therapy is not appropriate in COPD [30], and the major benefit of longacting inhaled bronchodilators is not due to an increase in potency but to duration of action [31]. Both b-agonists and anticholinergics abolish resting airway tone and improve airflow during extended periods of use [32,33]. Combining these drugs produces the following additional benefits.…”

Section: Drugs and The Secondary Prevention Of Copdmentioning

confidence: 99%

Drugs (including oxygen) in severe COPD

Albert¹,

Calverley²

2008

Eur Respir J

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Access to comprehensive guidelines on the management of chronic obstructive pulmonary disease (COPD) is now available, and several treatment goals of therapy have been identified from these guidelines, which have since been studied in clinical trials.Drug therapy is a key component of an individual patient's management plan, particularly in more severe disease. During the past few years, a number of new drug treatments have become available, although these are not always appropriately prescribed; this is particularly the case for oxygen.For patients with a history of exacerbations, there is good evidence for the use of inhaled longacting anticholinergic agents or combined inhaled steroids and long-acting b-agonists. Evidence for prophylactic antibiotics and antioxidant agents is lacking. Nutritional and calorie supplementation have not been shown to improve exercise capacity. Statins may improve outcomes in COPD, but prospective trials are needed to confirm this.The evidence for the use of long-term oxygen therapy in hypoxaemic patients is robust. Ambulatory oxygen improves exercise capacity, but whether it is used appropriately is in doubt. Overall, short burst oxygen therapy does not offer a benefit and therefore cannot be recommended.

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Addition of salmeterol to existing treatment in patients with COPD: a 12 month study

Cited by 89 publications

References 25 publications

Effects of Salmeterol on Sleeping Oxygen Saturation in Chronic Obstructive Pulmonary Disease

Effects of Salmeterol on Sleeping Oxygen Saturation in Chronic Obstructive Pulmonary Disease

Investigating New Standards for Prophylaxis in Reduction of Exacerbations—The INSPIRE Study Methodology

Drugs (including oxygen) in severe COPD

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