- TORCH study. Calverley PMA, Anderson JA, Celli B et al. Salmeterol and fluticasone propionate and survival in COPD. N Engl J Med 2007 February 22, 2007; 356(8): 775-89.
This was a randomised, double-blind trial comparing a combination inhaler with placebo, salmeterol alone, or fluticasone propionate alone.
Compared with placebo, the combination regimen reduced the annual rate of exacerbations from 1.13 to 0.85 and improved health status and spirometric values (p <0.001 for all comparisons with placebo).
- UPLIFT study. Tashkin DP, Celli B, Senn S et al for the UPLIFT Study Investigators. A 4-year trial of tiotropium in COPD. N Engl J Med 2008; 359: 1543-54.
In this study, the researchers investigated whether tiotropium attenuated the decline in FEV1 compared with placebo.
Mean absolute improvements in FEV1 in the tiotropium group were maintained throughout the trial (ranging from 87 to 103ml), compared with the placebo group (p <0.001).
At four years and 30 days, tiotropium was also found to be associated with a reduction in the risk of exacerbations, related hospitalisations and respiratory failure.
Contributed by Dr Simon Bourne, consultant in respiratory medicine, University Hospital Southampton NHS Foundation Trust.
- NICE. Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update). CG101. London, NICE, 2010. http://guidance.nice.org.uk/CG101
- An outcomes strategy for people with chronic obstructive pulmonary disease and asthma in England. 2010 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd Guidance/DH_127974
- NICE. Chronic Obstructive Pulmonary Disease quality standard. 2011 www.nice.org.uk/guidance/qualitystandards/chronicobstructive pulmonarydisease/copdqualitystandard.jsp
This topic falls under section 15.8 of the GP curriculum Respiratory Problems.
- www.copdeducation.org.uk An education website.
- www.copdexchange.co.uk An educational resource endorsed by the Primary Care Respiratory Society.
Contributed by Dr Simon Bourne, consultant in respiratory medicine, University Hospital Southampton NHS Foundation Trust