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Review: long acting β2 agonists and inhaled corticosteroids reduce exacerbations in chronic obstructive pulmonary disease
  1. Sandra Small, RN, MScN
  1. School of Nursing, Memorial University
    St John’s, Newfoundland, Canada

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Q What are the effects of common treatments for chronic obstructive pulmonary disease (COPD) on patient outcomes?


Embedded ImageData sources:

Medline (1980 to 1 May 2002), Cochrane Database of Systematic Reviews, bibliographies of published articles, and experts.

Embedded ImageStudy selection and assessment:

English language randomised controlled trials (RCTs) with ⩾3 months of follow up in adults with COPD that assessed long acting (LA) β2 agonists (β2As); LA inhaled anticholinergics (tiotropium); combined short acting (SA) β2As and SA anticholinergics; inhaled corticosteroids; combined inhaled corticosteroids and LAβ2As; pulmonary rehabilitation (with ⩾6 wks follow up); long term nocturnal non-invasive mechanical ventilation; domiciliary O2 therapy; or disease management. Analysis was restricted to RCTs with blinded ascertainment of outcomes {only drug interventions where placebo was possible}*, {>90%}* follow up data, and well balanced baseline characteristics in treatment and control groups.

Embedded ImageOutcomes:

COPD exacerbations and mortality.


The results are summarised in the table.

Summary of efficacy data for interventions for chronic obstructive pulmonary disease*


Long acting (LA) β2 agonists (β2As) and inhaled corticosteroids, with and without LAβ2As, reduce exacerbations but not mortality in patients with chronic obstructive pulmonary disease

A modified version of this abstract appears in ACP Journal Club and Evidence-Based Medicine.


The review by Sin et al contributes to the knowledge base on pharmacological and non-pharmacological management of COPD by going beyond evaluation of physiological endpoints, such as FEV1, to include patient centred outcomes, such as health related quality of life (HRQOL), exacerbations, and mortality. However, the search strategy was limited to English language studies, which could have had an impact on the findings.

COPD is a progressively debilitating condition that requires multimodal interventions to optimise health and functioning. Traditionally, SAβ2As and anticholinergic medications, alone or in combination, have been used for symptomatic relief of COPD. Recently, LA bronchodilators were introduced to achieve improvements in lung function for longer time periods. LAβ2As and anticholinergic medications, along with inhaled corticosteroids, improve HRQOL and reduce exacerbations in patients with moderate to severe COPD. Pulmonary rehabilitation, which may include exercise training, education, and behaviour modification, also improves HRQOL in such patients. Home oxygen prolongs survival but only in patients with resting hypoxia.

Disease management or self management programmes provide patients with the knowledge, skills, and support needed to manage their illness and aim to improve overall functioning. Although commonly acknowledged as an essential component of COPD care,1 efficacy of such programmes remains unclear, and more research is needed to evaluate effects on health outcomes. On the other hand, smoking cessation is the only measure that has been shown to slow decline in lung function and disease progression.2 Therefore, patients with COPD who smoke must have access to resources to help them to quit.



  • * Information provided by author.

  • For correspondence: Dr D D Sin, James Hogg iCAPTURE Centre for Pulmonary and Cardiovascular Research, Vancouver, British Columbia, Canada.

  • Sources of funding: Canadian Institutes of Health Research and Alberta Heritage Foundation for Medical Research.