The scientists analyzed 22 trials with 15,276 participants and found that common bronchodilators known as anticholinergics (tiotropium and ipratropium) reduced severe respiratory problems by 33 percent and respiratory-related deaths by 73 percent, compared to a placebo. However, the same scientific analysis (which combined the results of a number of studies) found that regularly inhaled beta-agonists (metaproterenol [Alupent], formoterol [Foradil], salmeterol [Serevent, Advair] and albuterol [Proventil, Ventolin, Volmax and others]) increased the risk of respiratory death more than twofold, compared to that of a a placebo.
The study found that niney-five percent of all inhalers prescribed for COPD treatment are beta-agonist inhalers. This means that doctors only prescribe anticholiergic inhalers a modest five percent of the time. "When patients used the anticholinergics, they experienced fewer severe (COPD) exacerbations requiring hospitalizations and fewer respiratory deaths than those taking only a placebo," says Edwin Salpeter, Professor of Physical Sciences Emeritus at Cornell University who led the statistical analysis in the study.
"These results suggest that anticholinergics should be the bronchodilator of choice in COPD," says Shelley Salpeter, clinical professor of medicine at Stanford's School of Medicine and doctor at Santa Clara Valley Medical Center in San Jose, California. "The long-term safety of beta-agonists in patients with COPD should be addressed."
So, what can you do to ensure your safety in lieu of this information? First, read up on all the literature as it relates to this analysis. Education is essential to making an informed decision. Next, talk with your health care provider about switching your beta-agonist inhaler to that of an anticholinergic, if this is something that you wish to do. Remember, you are the one who has to live with the choices that you make. Share your concerns and listen to the advice of your doctor. Together, both you and your health care provider can determine the best possible treatment plan for you and your COPD.
Finally, take the poll and I would love for you to share your comments and concerns. You can either leave a comment here, or, a discussion has started in the COPD Forum about this very topic. Click here to generate some buzz!
Further reading:
I use Symbicort, plus my doctor prescribed me Proventil and Albuterol. Aren’t these the same thing and why woould my doc prescribe me two of the same things? Seems concerning. Also, I tried to take you poll and it would not record the symbicort vote, very strange.
Hi Alan,
Your concerns are valid. Yes, Proventil and Albuterol are the same thing. They are both beta-agonist inhalers, therefore, I would question your doctor about taking both of them at the same time. Doing so is not recommended and you should check to see if one is not a CFC inhaler, as these have been banned since January due to the “powers that be” saying they are toxic to the environment. Proventil now comes in an HFA inhaler which is supposed to better for the environment, but there are many concerns that this is not true and that HFA inhalers do not work as well as the CFC inhalers. But that is a whole other Oprah and not answering your question.
Perhaps your Albuterol inhaler is an old one and the Proventil is newer? In that case, I am sure your doc wants you to use the newer one and certainly not both, as that would exceed the recommended dose of Albuterol and could cause untoward side effects.
Now, as far as your Symbicort is concerned, that contains two medicines, a steroid and formoterol, a beta-agoninst. I guess you have not been prescribed any anticholinergic inhalers, which is another thing you should talk with your doctor about, in light of the information provided in the blog today.
Let us know how it goes talking with your doctor. And, you can feel free to share your inhaler questions in the COPD forum:
http://forums.about.com/n/pfx/forum.aspx?folderId=15&listMode=13&nav=messages&webtag=ab-copd
Thank you for your comment and let me know if you have any more questions.
I take 3 of the mentioned prescriptions. I thought this was a good thing.
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Thanks for all you do.
Proventil, Advair and Spiriva. I have an appointment in April with my primary. I will surely go over this new info with him, and see if we can’t cut down on something. I’m retired and on Cobra until I’m old enough for Medicare. These Prescriptions aren’t cheap…not unlike COBRA.
Ok, let’s take a closer look at your inhaler situation:
Proventil is albuterol – a beta-agonist
Advair is salmeterol – a beta-agonist
Spiriva is tiotropium – an anticholinergic
As someone shared in the Forum, this is such a new analysis, it is not even posted yet in the Medical Journals,( that I could find at least), so, when you go see your doc, bring this up and see what she says. She may not even be aware of this. Please let me know what your doc says.
You can visit the forum for some interesting comments about this issue and more:
http://forums.about.com/n/pfx/forum.aspx?msg=113.1&webtag=ab-copd
Thanks for stopping by.
To date, only about 26% are using anticholincergics expressly, while the remaining are using a combo which contains a beta agonist, or a beta agonist alone. Interesting.
Hi could i get a copy of the study? would like to read in detail on the study
Sorry, all I find are articles similar to the one I wrote on the topic which means it may not be published yet. Please contact Krishna Ramanujan at ksr32@cornell.edu for more information and to see if you can get a copy of the study.