Lung function and symptom improvement with fluticasone propionate/salmeterol and ipratropium bromide/albuterol in COPD: response by beta-agonist reversibility

Pulm Pharmacol Ther. 2008 Aug;21(4):682-8. doi: 10.1016/j.pupt.2008.04.003. Epub 2008 May 1.


This retrospective analysis of data from two multi-center, randomized, double-blind, parallel group studies compared the efficacy of fluticasone propionate/salmeterol (FSC) 250/50 mcg twice daily with ipratropium bromide/albuterol (IB/ALB) 36/206 mcg four times daily in albuterol-reversible (n=320 [44%]) and non-reversible (n=399 [56%]) patients with COPD. In reversible and non-reversible patients, both treatments significantly increased FEV(1)AUC(0-6h) from baseline and the magnitude of improvement was larger in reversible patients. FSC increased FEV(1)AUC(0-6h) by 1.46+/-0.08 and 1.98+/-0.13 l-h at Day 1 and Week 8, respectively, in reversible patients, compared with 0.71+/-0.06 and 0.94+/-0.10 l-h in non-reversible patients (p<0.001). With IB/ALB, increases were 1.46+/-0.08 and 1.19+/-0.11 l-h at Day 1 in reversible patients and Week 8, respectively, and 0.89+/-0.06 and 0.74+/-0.09 l-h (p < or = 0.041) in non-reversible patients. After 8 weeks, in both the reversible and non-reversible populations, the FEV(1) AUC(0-6h) significantly increased with FSC treatment (p < or = 0.002) and significantly decreased with IB/ALB (p < or = 0.010). In both reversibility groups, improvement in Transition Dyspnea Index (TDI) scores, overall daytime diary symptom scores and nocturnal symptom measures were significantly greater with FSC treatment compared with IB/ALB (p < or = 0.044). Reversibility status was not predictive of the magnitude of reduction in symptom scores. We conclude that both reversible and non-reversible patients receive greater clinical benefit with FSC compared with IB/ALB and acute bronchodilator reversibility is not useful for differentiating patients based on symptomatic responses to FSC compared with IB/ALB.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Agonists / pharmacology
  • Adrenergic beta-Agonists / therapeutic use*
  • Aged
  • Albuterol / analogs & derivatives
  • Albuterol / pharmacology
  • Albuterol / therapeutic use
  • Albuterol, Ipratropium Drug Combination
  • Androstadienes / pharmacology
  • Androstadienes / therapeutic use
  • Area Under Curve
  • Bronchodilator Agents / pharmacology
  • Bronchodilator Agents / therapeutic use*
  • Drug Combinations
  • Female
  • Fluticasone-Salmeterol Drug Combination
  • Forced Expiratory Volume
  • Humans
  • Ipratropium / pharmacology
  • Ipratropium / therapeutic use
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Randomized Controlled Trials as Topic
  • Respiratory Function Tests
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors


  • Adrenergic beta-Agonists
  • Albuterol, Ipratropium Drug Combination
  • Androstadienes
  • Bronchodilator Agents
  • Drug Combinations
  • Fluticasone-Salmeterol Drug Combination
  • Ipratropium
  • Albuterol