Saturday, 26 March 2011

Clinical trial: Preventing COPD exacerbations, drug comparison

SPIRIVA was SUPERIOR to SEREVENT in prevention of COPD attacks in moderate and severe COPD patients.

What is COPD?

COPD stand for chronic obstructive pulmonary disease. There are 2 diseases included in COPD, these are emphysema and chronic bronchitis. Emphysema is defined in pathologic terms and is defined as destruction of the air sacs of the lung responsible for oxygen transfer into blood. Chronic bronchitis on the other hand is a clinical diagnosis with it being defined as cough with productive sputum (phlegm) for 3 consecutive months in 2 consecutive years.

there are many treatments available for COPD and involved usually a combination of a longer acting controller and a short acting rescue drug.

If you have been diagnosed with COPD, print this out. checklist for COPD

In the New England Journal of Medicine (march 2011 issue). Vogelmeier and his group have compared 2 effective inhalers for prevention of COPD attacks.

Attacks of COPD are essentially spells of increased shortness of breath and cough with sputum and can be triggered by infections, allergies or irritants in the air. Both tiotropium inhaled (know as SPIRIVA in USA, Boehringer Inc) and Salmeterol (known as SEREVENT DISKUS in USA, GSK) are recommended as controller medications for moderate to severe asthma.

A few studies have been done in the past which showed no difference in outcomes between the two but these were shorter term studies 3-6 months. This study compared head-to-head if one was better than the other and followed patients over a year. The group gathered data from about 6000 participants who were selected based on specific selection criteria.

Comparison goals were time to first attack, number of attacks, deaths and time for attack to subside.

Here are the results:

1. probability that patient will discontinue the medication was LOWER with SPIRIVA

This means that patient stay longer on the medication and get helped more.

2. Time to first exacerbation was LOWER with SPIRIVA

patients with SPIRIVA had exacerbations on an average 42 days later than those on SERVENT. This means SPIRIVA tends to control the COPD better than SERVENT.

3. Annual rate of exacerbations was LOWER with SPIRIVA

There were 11% MORE exacerbations when patients were on SERVENT


SPIRIVA was SUPERIOR to SEREVENT in prevention of COPD attacks in moderate and severe COPD patients.

Both SPIRIVA and SERVENT act to expand the air ways and improve air flow. SPIRIVA acts but blocking the cholinergic nerves while SERVENT acts by stimulating the adrenegic nerves. This study compares the two and provides good evidence that tiotropium is better. Thought there may be a difference in the way the drug reaches the lung and would have affected the results but the bottom line is that tiotropium did better than salmeterol.

Talk to your doctor! see what works out for you!! and oh yes DONT SMOKE if you have COPD.

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  1. Chronic obstructive lung disease (COPD) is a progressive disease that makes it difficult to breathe. The main cause of COPD is cigarette smoking.

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