BMJ  2007;334:864 (28 April), doi:10.1136/bmj.39191.719352.3A

Letters

COPD

Drug management of COPD

The first 150 words of the full text of this article appear below.

In the second step of prescribing for long term management of chronic obstructive pulmonary disease, McIvor and Little recommend the addition of a long acting ₂ agonist (LABA) to a short acting ₂ agonist as needed, supplemented by stepwise addition of regular short or long acting anticholinergic inhalers.¹ I agree with this, and it is supported by evidence; tiotropium has advantages over a LABA. The National Institute for Health and Clinical Excellence (NICE) also recommends adding a LABA in its COPD guideline (No12, 2004).² At that time there was no evidence to show whether this was a useful combination, but now evidence shows the addition of LABA to tiotropium has no additional benefit over tiotropium alone,³ so this is not really a suitable option.

The authors' next step is to add an inhaled corticosteroid or a combination of inhaled corticosteroid and LABA as a single inhaler. If an inhaled corticosteroid is to . . . [Full text of this article]

Derbyshire County Primary Care Trust, Chesterfield S41 7PF

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Relevant Article

Chronic obstructive pulmonary disease

Andrew McIvor and Paul Little
BMJ 2007 334: 798. [Extract] [Full Text] [PDF]

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Correction to Drug management of COPD

Peter D Burrill
bmj.com, 30 Apr 2007 [Full text]