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Am. J. Respir. Crit. Care Med., Volume 163, Number 5, April 2001, 1087-1092

Use of a Long-acting Inhaled beta 2-Adrenergic Agonist, Salmeterol Xinafoate, in Patients with Chronic Obstructive Pulmonary Disease

STEPHEN I. RENNARD, WAYNE ANDERSON, RICHARD ZuWALLACK, JOSEPH BROUGHTON, WILLIAM BAILEY, MITCHELL FRIEDMAN, MICHAEL WISNIEWSKI, and KATHLEEN RICKARD

University of Nebraska Medical Center, Omaha, Nebraska; Glaxo Wellcome, Research Triangle Park, North Carolina; University of Connecticut School of Medicine, Farmington, Connecticut; Colorado Pulmonary Associates, Denver, Colorado; University of Alabama at Birmingham Lung Health Center, Birmingham, Alabama; and Tulane University Medical Center, New Orleans, Louisiana

Chronic obstructive pulmonary disease (COPD) is a condition in which continuous bronchodilation may have clinical advantages. This study evaluated salmeterol, a beta -agonist bronchodilator with a duration of action substantially longer than that of short-acting beta -agonists, compared with ipratropium, an anticholinergic bronchodilator, and placebo in patients with COPD. Four hundred and five patients with COPD received either salmeterol 42 µg twice daily, ipratropium bromide 36 µg four times daily, or placebo for 12 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. Bronchodilator response was measured over 12 h four times during the treatment period. Salmeterol provided similar maximal bronchodilatation to ipratropium but had a longer duration of action and a more constant bronchodilatory effect with no evidence of bronchodilator tolerance. Both active treatments were well tolerated. Salmeterol was an effective bronchodilator with a consistent effect over this 12-wk study in patients with COPD, including those "unresponsive" to albuterol. The long duration of action of salmeterol offers the advantage of twice daily dosing compared with the required four times a day dosing with ipratropium.




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