CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Regular inhaled short acting ß₂ agonists for the management of stable chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis

F S F Ram¹, P Sestini²

¹ St George’s Hospital Medical School, Department of Physiological Medicine, University of London, UK
² University of Sienna, Department of Clinical Medicine and Immunological Sciences, Italy

Correspondence to:
Correspondence to:
Dr F S F Ram, St George’s Hospital Medical School, Department of Physiological Medicine, Cranmer Terrace, London SW17 0RE, UK;
fram{at}sghms.ac.uk

Background: Despite the lack of reversibility, patients with chronic obstructive pulmonary disease (COPD) often report symptomatic improvement with inhaled short acting ß₂ agonist bronchodilators (ISABAs) in the management of both stable and acute exacerbations of COPD. A review of the literature was undertaken to determine the effectiveness of regular treatment with ISABAs compared with placebo in stable COPD.

Methods: A search for randomised controlled trials was carried out using the Cochrane Collaboration database of trials up to and including May 2002.

Results: Thirteen studies of 7 days to 8 weeks in duration on 237 patients aged 56–70 years with forced expiratory volume in 1 second (FEV₁) 60–70% predicted were included in the review. All studies used a crossover design with adequate washout periods and were of high methodological quality. ISABA was delivered either through a nebuliser or a pressurised metered dose inhaler. Spirometric tests performed at the end of the study and after the treatment (post-bronchodilator) showed a slight but significant increase in FEV₁ and forced vital capacity (FVC) compared with placebo. In addition, both morning and evening peak expiratory flow rate (PEFR) were significantly better during active treatment than during placebo. An improvement in the daily breathlessness score was observed with ISABA treatment. The risk of treatment failure was reduced by more than 50% with ISABA. Preference for ISABA was nine times higher than for placebo.

Conclusions: Use of ISABA on a regular basis for at least 7 days in patients with stable COPD is associated with improvements in post-bronchodilator lung function and decreases in both breathlessness and treatment failure. This review has shown that regular administration of ISABAs is an effective and inexpensive treatment for the management of patients with stable COPD.

Keywords: chronic obstructive pulmonary disease; bronchodilator; meta-analysis; review

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