Effects of long-acting bronchodilators in COPD patients according to COPD severity and ICS use

Respir Med. 2013 Feb;107(2):223-32. doi: 10.1016/j.rmed.2012.10.022. Epub 2012 Dec 6.


Background: Indacaterol is a once-daily, long-acting β(2)-agonist bronchodilator that improves dyspnoea and health status in patients with moderate-to-severe COPD. While its bronchodilator effects have been shown to be maintained in different patient subgroups, effects on clinical outcomes in certain subgroups are not yet defined.

Methods: Post-hoc analysis of pooled clinical study data to investigate efficacy and safety of indacaterol compared with placebo and other long-acting bronchodilators (formoterol, salmeterol, open-label tiotropium) in patient subgroups defined by COPD severity (GOLD stage II or III; n = 4082) and ICS use at baseline (no/yes; n = 4088). Efficacy outcomes were trough (24-h post-dose) FEV(1), dyspnoea (transition dyspnoea index; TDI) and health status (St George's Respiratory Questionnaire; SGRQ) after 26 weeks.

Results: All active treatments significantly improved trough FEV(1) and dyspnoea compared with placebo, and all apart from open-label tiotropium improved health status compared with placebo. Among active treatments, indacaterol 150 μg had the best overall efficacy profile in the GOLD II and no-ICS subgroups. In the GOLD III and ICS subgroups, indacaterol 300 μg had the best overall efficacy, including a marked effect on dyspnoea (1.4-point improvement in TDI total score vs. placebo; p < 0.001). Within subgroups, the incidence of adverse events was similar between treatments.

Conclusion: Indacaterol maintained its efficacy regardless of disease severity or use of concurrent ICS. Indacaterol 150 μg had the best overall efficacy profile in the GOLD stage II patients while, in patients with more severe disease, indacaterol 300 μg provided useful improvements in dyspnoea.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adrenergic beta-2 Receptor Agonists / administration & dosage
  • Adrenergic beta-2 Receptor Agonists / therapeutic use
  • Adult
  • Aged
  • Albuterol / administration & dosage
  • Albuterol / analogs & derivatives
  • Albuterol / therapeutic use
  • Bronchodilator Agents / administration & dosage*
  • Bronchodilator Agents / therapeutic use
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Dyspnea / drug therapy
  • Dyspnea / etiology
  • Ethanolamines / administration & dosage
  • Ethanolamines / therapeutic use
  • Female
  • Forced Expiratory Volume / drug effects
  • Formoterol Fumarate
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / therapeutic use
  • Humans
  • Indans / administration & dosage*
  • Indans / therapeutic use
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Quinolones / administration & dosage*
  • Quinolones / therapeutic use
  • Randomized Controlled Trials as Topic
  • Salmeterol Xinafoate
  • Scopolamine Derivatives / administration & dosage
  • Scopolamine Derivatives / therapeutic use
  • Severity of Illness Index
  • Tiotropium Bromide
  • Treatment Outcome
  • Vital Capacity / drug effects


  • Adrenergic beta-2 Receptor Agonists
  • Bronchodilator Agents
  • Ethanolamines
  • Glucocorticoids
  • Indans
  • Quinolones
  • Scopolamine Derivatives
  • Salmeterol Xinafoate
  • indacaterol
  • Albuterol
  • Formoterol Fumarate
  • Tiotropium Bromide