Chest 2008;134:255-262.

Combination therapy with tiotropium and formoterol achieves great improvement in daytime lung function (FEV1) in patients with moderate COPD than does salmeterol and fluticasone.

Dr. Klaus F. Rabe of Leiden University Medical Center and colleagues note that inhaled corticosteroids such as fluticasone along with a long-acting bronchodilator is a popular choice for patients with COPD. However, they observe, use of two bronchodilators from different classes might be of greater help.

To investigate, the researchers studied 592 patients with moderate COPD who were randomized to treatment with once daily tiotropium and twice daily formoterol or twice daily salmeterol and twice daily fluticasone.

At 6 weeks, the team found that the 12-hour FEV1 profile in the tiotropium-formoterol combination patients was generally higher than in those given the salmeterol-fluticasone combination. Other measures of lung function also favored the tiotropium group.

Both treatments were well tolerated.

The findings, say the investigators, "support current treatment recommendations in moderate COPD to combine two bronchodilators of different classes rather than to add an inhaled corticosteroid," if a single bronchodilator is not sufficient.

Given these results, the researchers conclude, "Long-term studies in patients with severe COPD are warranted to assess the relative efficacy of different treatment combinations."