Use of a long-acting inhaled beta(2)-adrenergic agonist, salmeterol xinafoate, in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a condition in which contin uous bronchodilation may have clinical advantages. This study evaluated sal meterol, a beta -agonist bronchodilator with a duration of action substanti ally longer than that of short-acting beta -agonists, compared with Ipratro pium, an anticholinergic bronchodilator, and placebo in patients with COPD. Four hundred and five patients with COPD received either salmeterol 42 mug twice daily, ipratropium bromide 36 mug four times daily, or placebo for 1 2 wk in this randomized, double-blind, parallel-group study. Patients were stratified on the basis of bronchodilator response to albuterol (> 12% and > 200-ml improvement) and were randomized within each stratum. Bronchodilat or response was measured over 12 h four times during the treatment period. Salmeterol provided similar maximal bronchodilatation to ipratropium but ha d a longer duration of action and a more constant bronchodilatory effect wi th no evidence of bronchodilator tolerance. Both active treatments were wel l tolerated. Salmeterol was an effective bronchodilator with a consistent e ffect over this 12-wk study in patients with COPD, including those "unrespo nsive" to albuterol. The long duration of action of salmeterol offers the a dvantage of twice daily dosing compared with the required four times a day dosing with ipratropium.