COPD Patients Discover Less Is More

Edition: October 2001 - Vol 9 Number 10
Article#: 1068
Author: Laura Thill

Asthma patients may not be as dependent on their medication as they have assumed, according to Fadi Sabbagh, MD, chief pulmonary fellow, and Linda Efferen, MD, associate professor of clinical medicine, Department of Pulmonary and Critical Care Medicine, State University of New York Health Science Center, Brooklyn, N.Y. In a study by D. Cook, G. Guyatt, E. Wong, et. al. ("Regular vs. As-Needed Short Acting Inhaled Beta-Agonist Therapy for Chronic Obstructive Pulmonary Disease," Am J Respir Crit Care Med. 2001; 163:85-90.), researchers show that COPD patients may benefit no more from regular use of inhaled short-acting beta-agonist therapy than from the same treatment on an as-needed basis.

Patients included in the study has the following characteristics:

•50 years or older.

•Clinical diagnosis of COPD.

•Smoking history of over 20 pack-years.

•Forced expiratory volume in one second (FEV1) less than or equal to 70 percent predicted.

•FEV1/vital capacity ratio less than or equal to 0.7 after 20 mcg of albuterol.

•At least three daily activities limited by exertional dyspnea.

Those individuals with the following characteristics were not included in the study:

•15 percent or greater increase in FEV1 over their baseline value following albuterol.

•Exertional dyspnea secondary to other conditions.

•Exercise restrictions unrelated to dyspnea.

•Unable to discontinue oral corticosteroids or theophylline preparations during testing.

Participants were trained in inhaling technique as needed. Baseling spirometry was performed no sooner than four hours following caffeine intake or use of bronchodilators. Individuals receiving doses of ipratropium bromide under 160 mcg were given treatment for a one-month test period. Those receiving under 1000 mcg beclomethasone daily or less than 800 mcg budesonide daily were treated with one or the other of these medications for a two-month test period.

During testing, theophylline preparations were stopped. Subjects charted their condition in a symptom and peak-flow diary for the first half of the test period. They were then retested with spirometry to ensure they were eligible test subjects. At this point, subjects were not randomized if they:

•Received under 75 percent of prescribed bronchodilators (according to canister weight).

•Depended on theophylline.

•Could not tolerate ipratropium or inhaled corticosteroids.

Remaining subjects went on to receive active or placebo albuterol at 100 mcg/puff, two puffs four times daily for three months. They also were given open-label albuterol if necessary.

Patients were tested for outcomes of spirometry, a six-minute walk and a quality-of-life questionnaire.


The researchers discovered no significant difference in spirometry or peak-flow rates for patients who used albuterol regularly versus as was necessary, according to Sabbagh and Efferen. (There was, however, some difference in peak flow measured at home, after medication versus before medication.) The two groups had similar outcomes for the six-minute walk and dyspnea after walking. General symptoms of dyspnea, cough or sputum also were similar for the two groups.

Essentially, note Sabbagh and Efferen, the researchers showed that using albuterol on an as-needed basis means less medication for patients, and it does not appear that quality of life will be compromised compared with patients who use albuterol regularly.