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COPD 'slippery slope' slowed by long-acting ß2-agonists

Patients with chronic obstructive pulmonary disease can benefit from long-acting ß2-agonists, even when their lung function appears to have declined irreversibly, new research suggests.

By helping COPD patients feel less breathless while exercising, the long-acting drugs could slow their 'slippery slope' to declining health, according to the research published in Thorax (June).

Exercise testing of patients with severe COPD found two weeks of treatment with the long-acting ß2-agonist salmeterol reduced breathlessness and over-inflation of the lungs, despite having little impact on spirometric measurements.

While patients were unable to walk further, they felt better about their breathlessness – suggesting the treatment could help to keep them active.

Lead researcher Dr William Man, clinical research fellow at King's College Hospital in London, said drugs could help patients feel less breathless, even when there was no change in the traditional measurement of FEV1.

'What the paper shows is that we should go more by what a patient says about their symptoms than just the FEV1,' he added.

Professor David Price, professor of primary care respiratory medicine at the University of Aberdeen and a GP in Norwich, said: 'Long-acting bronchodilators show a big improvement in the quality of life of patients that we would not expect from the change we see in lung function.'

He suggested long-acting ß2-agonists were relieving air trapping in patients with COPD, in turn helping to reduce breathlessness. 'Patients have extreme activity limitation in early COPD. With effective treatment they learn not to give up too early – it's a slippery slope once they give up.'

Professor Price said GPs needed to be 'aggressive' in identifying how patients' activity is limited, as this was a more useful indication of their condition than spirometry alone. 'GPs and respiratory nurses are very good at asking the right questions, but sometimes we concentrate on the science too much,' he added.

NICE guidelines recommend long-acting ß2-agonists for patients who have two or more exacerbations per year, or where short-acting drugs have failed.

By Rob Finch

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