Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 2003 Jul;58(7):580–584. doi: 10.1136/thorax.58.7.580

Regular inhaled short acting ß2 agonists for the management of stable chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis

F Ram 1, P Sestini 1
PMCID: PMC1746735  PMID: 12832670

Abstract

Background: Despite the lack of reversibility, patients with chronic obstructive pulmonary disease (COPD) often report symptomatic improvement with inhaled short acting ß2 agonist bronchodilators (ISABAs) in the management of both stable and acute exacerbations of COPD. A review of the literature was undertaken to determine the effectiveness of regular treatment with ISABAs compared with placebo in stable COPD.

Methods: A search for randomised controlled trials was carried out using the Cochrane Collaboration database of trials up to and including May 2002.

Results: Thirteen studies of 7 days to 8 weeks in duration on 237 patients aged 56–70 years with forced expiratory volume in 1 second (FEV1) 60–70% predicted were included in the review. All studies used a crossover design with adequate washout periods and were of high methodological quality. ISABA was delivered either through a nebuliser or a pressurised metered dose inhaler. Spirometric tests performed at the end of the study and after the treatment (post-bronchodilator) showed a slight but significant increase in FEV1 and forced vital capacity (FVC) compared with placebo. In addition, both morning and evening peak expiratory flow rate (PEFR) were significantly better during active treatment than during placebo. An improvement in the daily breathlessness score was observed with ISABA treatment. The risk of treatment failure was reduced by more than 50% with ISABA. Preference for ISABA was nine times higher than for placebo.

Conclusions: Use of ISABA on a regular basis for at least 7 days in patients with stable COPD is associated with improvements in post-bronchodilator lung function and decreases in both breathlessness and treatment failure. This review has shown that regular administration of ISABAs is an effective and inexpensive treatment for the management of patients with stable COPD.

Full Text

The Full Text of this article is available as a PDF (223.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cleophas T. J. Carry-over biases in clinical pharmacology. Eur J Clin Chem Clin Biochem. 1993 Dec;31(12):803–809. doi: 10.1515/cclm.1993.31.12.803. [DOI] [PubMed] [Google Scholar]
  2. Cook D., Guyatt G., Wong E., Goldstein R., Bedard M., Austin P., Ramsdale H., Jaeschke R., Sears M. Regular versus as-needed short-acting inhaled beta-agonist therapy for chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001 Jan;163(1):85–90. doi: 10.1164/ajrccm.163.1.2004214. [DOI] [PubMed] [Google Scholar]
  3. Dullinger D., Kronenberg R., Niewoehner D. E. Efficacy of inhaled metaproterenol and orally-administered theophylline in patients with chronic airflow obstruction. Chest. 1986 Feb;89(2):171–173. doi: 10.1378/chest.89.2.171. [DOI] [PubMed] [Google Scholar]
  4. Formgren H., Sjökvist A., Ståhl E., Wirén J. E. Terbutaline in COPD comparison between Turbuhaler and chlorofluorocarbon (CFC) inhaler. Lung. 1994;172(5):271–280. doi: 10.1007/BF00164309. [DOI] [PubMed] [Google Scholar]
  5. Guyatt G. H., Berman L. B., Townsend M., Pugsley S. O., Chambers L. W. A measure of quality of life for clinical trials in chronic lung disease. Thorax. 1987 Oct;42(10):773–778. doi: 10.1136/thx.42.10.773. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Guyatt G. H., Townsend M., Keller J. L., Singer J. Should study subjects see their previous responses: data from a randomized control trial. J Clin Epidemiol. 1989;42(9):913–920. doi: 10.1016/0895-4356(89)90105-4. [DOI] [PubMed] [Google Scholar]
  7. Guyatt G. H., Townsend M., Nogradi S., Pugsley S. O., Keller J. L., Newhouse M. T. Acute response to bronchodilator. An imperfect guide for bronchodilator therapy in chronic airflow limitation. Arch Intern Med. 1988 Sep;148(9):1949–1952. doi: 10.1001/archinte.148.9.1949. [DOI] [PubMed] [Google Scholar]
  8. Hansen N. C., May O. Domiciliary nebulized terbutaline in severe chronic airways obstruction. Eur Respir J. 1990 Apr;3(4):463–464. [PubMed] [Google Scholar]
  9. Ikeda A., Nishimura K., Koyama H., Tsukino M., Hajiro T., Mishima M., Izumi T. Comparison of the bronchodilator effects of salbutamol delivered via a metered-dose inhaler with spacer, a dry-powder inhaler, and a jet nebulizer in patients with chronic obstructive pulmonary disease. Respiration. 1999;66(2):119–123. doi: 10.1159/000029352. [DOI] [PubMed] [Google Scholar]
  10. Iversen E. T., Sørensen T., Heckscher T., Jensen J. I. Effect of terbutaline on exercise capacity and pulmonary function in patients with chronic obstructive pulmonary disease. Lung. 1999;177(4):263–271. doi: 10.1007/PL00007646. [DOI] [PubMed] [Google Scholar]
  11. Jaeschke R., Guyatt G. H., Singer J., Keller J., Newhouse M. T. Mechanism of bronchodilator effect in chronic airflow limitation. CMAJ. 1991 Jan 1;144(1):35–39. [PMC free article] [PubMed] [Google Scholar]
  12. Klock L. E., Miller T. D., Morris A. H., Watanabe S., Dickman M. A comparative study of atropine sulfate and isoproterenol hydrochloride in chronic bronchitis. Am Rev Respir Dis. 1975 Sep;112(3):371–376. doi: 10.1164/arrd.1975.112.3.371. [DOI] [PubMed] [Google Scholar]
  13. Light R. W., Summer W. R., Luchsinger P. C. Response of patients with chronic obstructive lung disease to the regular administration of nebulized isoproterenol. A double-blind crossover study. Chest. 1975 Jun;67(6):634–639. doi: 10.1378/chest.67.6.634. [DOI] [PubMed] [Google Scholar]
  14. Pauwels R. A., Buist A. S., Ma P., Jenkins C. R., Hurd S. S., GOLD Scientific Committee Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): executive summary. Respir Care. 2001 Aug;46(8):798–825. [PubMed] [Google Scholar]
  15. Shah S. S., Johnston D., Woodcock A. A., Johnson M., Geddes D. M. Breathlessness and exercise tolerance in chronic airflow obstruction: 2-hourly versus 4-hourly salbutamol by inhalation. Curr Med Res Opin. 1983;8(5):345–349. doi: 10.1185/03007998309112395. [DOI] [PubMed] [Google Scholar]
  16. Siafakas N. M., Vermeire P., Pride N. B., Paoletti P., Gibson J., Howard P., Yernault J. C., Decramer M., Higenbottam T., Postma D. S. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J. 1995 Aug;8(8):1398–1420. doi: 10.1183/09031936.95.08081398. [DOI] [PubMed] [Google Scholar]
  17. Silins R. A., Marlin G. E. Evaluation of domiciliary treatment with terbutaline by wet nebulisation in patients with chronic bronchitis and emphysema. Aust N Z J Med. 1985 Apr;15(2):230–234. doi: 10.1111/j.1445-5994.1985.tb04014.x. [DOI] [PubMed] [Google Scholar]
  18. Tandon M. K., Kailis S. G. Bronchodilator treatment for partially reversible chronic obstructive airways disease. Thorax. 1991 Apr;46(4):248–251. doi: 10.1136/thx.46.4.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Taylor D. R., Buick B., Kinney C., Lowry R. C., McDevitt D. G. The efficacy of orally administered theophylline, inhaled salbutamol, and a combination of the two as chronic therapy in the management of chronic bronchitis with reversible air-flow obstruction. Am Rev Respir Dis. 1985 May;131(5):747–751. doi: 10.1164/arrd.1985.131.5.747. [DOI] [PubMed] [Google Scholar]
  20. Wilson R. S., Connellan S. J. Domiciliary nebulised salbutamol solution in severe chronic airway obstruction. Thorax. 1980 Nov;35(11):873–876. doi: 10.1136/thx.35.11.873. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES