Role of longacting bagnoistsdo they act mainly on quality of life rather than on lung function variables

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There is increasing evidence that long-acting b2-agonist treatment is effective for patients with COPD. This treatment has been shown to increase FEV1 and peak flow, improve symptom control and improve quality of life compared with 'prn' use of short-acting b-agonist therapy [7,8]. Treatment with a long-acting b-agonist bronchodilator is likely to be of greatest benefit if prescribed for patients with persistent symptoms despite the use of short-acting b-agonists on a 'prn' basis. Some trials have shown a reduction in exacerbation rates or delay in the time to first exacerbation during treatment with long-acting b2-agonists [9].

Long-acting b-agonists have been shown to be more effective than short acting anticholinergic agents in some studies [9]. Recently published evidence suggests that a long-acting anticholinergic agent (tiotropium bromide) is at least as effective as salmeterol and possible more effective for patients with COPD (see Chapter 11 on future treatments for COPD) [20].

If a patient with COPD is prescribed a long-acting b-agonist, they should continue to use their short-acting bronchodilator inhaler on a 'prn' basis for episodes of breathlessness. There is some evidence that combined treatment with salmeterol and anticholinergic treatment (ipratropium bromide) or with oral theophylline treatment is more effective than treatment with salmeterol alone [10,11].

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