Nursing

Salmeterol and fluticasone propionate can slow the rate of decline in lung function in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD), researchers report in the Aug. 15 issue of the American Journal of Respiratory and Critical Care Medicine.

Bartolome R. Celli, M.D., from Tufts University School of Medicine in Boston, and colleagues analyzed data on the rate of decline in lung function from a trial that had randomly assigned 5,343 patients (in 42 countries) with moderate or severe COPD to 50 μg salmeterol plus 500 μg fluticasone propionate, either drug alone, or placebo. Spirometry was then performed every 24 weeks for three years.

The researchers found that the adjusted rate of decline in post-bronchodilator forced expiratory volume in one second (FEV₁) was 55 mL/year for placebo, 42 mL/year for either salmeterol or fluticasone propionate alone, and 39 mL/year for both drugs combined. The results were statistically significant for all three treatment groups compared with placebo. FEV₁ declined faster in current smokers, those with a lower body mass index and in patients who exacerbated more frequently, the report indicates. The decline in FEV₁ also varied depending on world region.

The study "provides the first possible evidence that lung function decline can be slowed with medications," Samy Suissa, Ph.D., from McGill University in Montreal, Quebec, Canada, writes in an accompanying editorial. "It also provides further evidence that use of inhaled corticosteroids, alone or in combination, in COPD is unnecessary and thus inappropriate."

The study was funded by GlaxoSmithKline, and several authors disclosed financial ties to GSK and other pharmaceutical companies. The author of the editorial also disclosed financial ties to pharmaceutical companies.

Abstract
Full Text (subscription or payment may be required)
Editorial

Prepared jointly by the editors of RN and HealthDay's Physicians' Briefing (www.physiciansbriefing.com).