Two Inhalers Are Better Than One for COPD

March 1, 2007

A publicly funded Canadian clinical trial has revealed that combining the inhalers Spiriva (tiotropium) and Advair (fluticasone/salmeterol) resulted in improved quality of life, improved lung function and fewer hospitalizations among people with severe chronic obstructive pulmonary disease (COPD).

“We knew that many doctors were prescribing multiple different inhalers to patients, but this is the first study to evaluate the safety and efficacy of this practice,” said lead author Dr. Shawn Aaron, a senior scientist at the Ottawa Health Research Institute, associate professor of Medicine at the University of Ottawa, and respirologist at The Ottawa Hospital.

The randomized, double-blind study followed 449 patients for one year in 27 Canadian hospitals and medical centers. Patients who received Spiriva and Advair scored twice as high in a quality of life assessment compared to patients taking Spiriva and a placebo. The combination therapy also decreased the number of hospitalizations for COPD by 47 percent and increased lung function by 5 percent, compared to Spiriva and a placebo.

“Although a 5-percent increase in lung function may not sound like a lot, you have to remember that these people may only have 25 percent of normal lung function to begin with,” Aaron said. “This could allow some people to walk around the block for the first time in years.”

The study also evaluated disease exacerbations and serious adverse effects. No significant differences were observed. A third arm of the study looked at patients taking Spiriva plus salmeterol (one component of Advair).This combination was not as beneficial as Spiriva plus Advair.

Although Spiriva and Advair are made by pharmaceutical companies, the study was conceived, designed and conducted by independent academic researchers funded by public agencies ($1.5 million from the Canadian Institutes of Health Research (CIHR) and $50,000 from the Ontario Thoracic Society).

The study will be published in the Annals of Internal Medicine established by the American College of Physicians on April 17.