Am. J. Respir. Crit. Care Med., Volume 163, Number 1, January 2001, 85-90

Regular Versus As-Needed Short-Acting Inhaled -Agonist Therapy for Chronic Obstructive Pulmonary Disease

DEBORAH COOK, GORDON GUYATT, ERIC WONG, ROGER GOLDSTEIN, MICHEL BEDARD, PEGGY AUSTIN, HELEN RAMSDALE, ROMAN JAESCHKE, and MALCOLM SEARS

Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario; Department of Medicine, University of Alberta, Edmonton, Alberta; and Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Regular short-acting inhaled -agonist therapy is of uncertain benefit in patients with chronic obstructive pulmonary disease (COPD). We conducted a randomized, concealed, double-blind, placebo-controlled crossover trial in two periods, each of 3-mo duration, involving 53 patients with a smoking history of > 20 pack-years, an FEV₁ of < 70% predicted, and an FEV₁/VC ratio of < 0.7 after inhalation of 200 µg albuterol. All patients received regular ipratropium bromide at 20 µg per puff in 2 puffs four times daily, beclomethasone at 250 µg per puff or equivalent corticosteroid in 2 puffs twice daily, and open-label inhaled albuterol as needed. Interventional therapy consisted of regular inhaled albuterol (100 µg per puff, in 2 puffs four times daily) versus placebo. Patients used twice as much active albuterol in the regular use period (mean: 8.07 puffs of coded and 4.68 puffs of open-label medication; total: 12.75 puffs daily) than during the as-needed period (mean: 6.34 puffs of open-label albuterol daily). Despite greater -agonist use, patients showed similar results during treatment and control periods for all outcomes. Differences between active and placebo periods were: FEV₁: 0.04 L (95% confidence interval [CI]: 0.09 to 0.01 L); slow vital capacity: 0.04 L (95% CI: 0.12 to 0.20 L); 6-min walk test distance: 3.1 m (95% CI: 16.8 to 10.5 m); and Chronic Respiratory Questionnaire scores for dyspnea: 0.02 (95% CI: 0.13 to 0.16); fatigue: 0.02 (95% CI: 0.25 to 0.20); mastery: 0.01 (95% CI: 0.20 to 0.24); and emotional function: 0.02 (95% CI: 0.20 to 0.24). We found that in patients with COPD, use of regular short-acting inhaled -agonists resulted in twice as much -agonist use without physiologic or clinical benefit as did use on an as-needed basis.

This article has been cited by other articles:

				E. R. Sutherland and R. M. Cherniack Management of Chronic Obstructive Pulmonary Disease N. Engl. J. Med., June 24, 2004; 350(26): 2689 - 2697. [Full Text] [PDF]

				H. J. Schunemann, L. Griffith, R. Jaeschke, R. Goldstein, D. Stubbing, P. Austin, and G. H. Guyatt A Comparison of the Original Chronic Respiratory Questionnaire With a Standardized Version Chest, October 1, 2003; 124(4): 1421 - 1429. [Abstract] [Full Text] [PDF]

				F S F Ram and P Sestini Regular inhaled short acting {beta}2 agonists for the management of stable chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis Thorax, July 1, 2003; 58(7): 580 - 584. [Abstract] [Full Text] [PDF]

				M. J. TOBIN Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2001 Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 642 - 662. [Full Text] [PDF]

				Managing stable chronic obstructive pulmonary disease DTB, November 1, 2001; 39(11): 81 - 85. [Abstract] [Full Text] [PDF]

				Is Regularly Inhaled Albuterol Beneficial in COPD? Journal Watch (General), February 9, 2001; 2001(209): 3 - 3. [Full Text]