For patients with mild COPD, both drugs appear equally effective, the study authors noted.
"These data suggest that, in patients with moderate-to-very severe COPD and a history of exacerbations, tiotropium [Spiriva] should be considered first choice over salmeterol [Serevent] as maintenance treatment," Vogelmeier said.
Why one medication is better than the other at reducing flare-ups isn't clear, said senior study author Dr. Leonardo Fabbri, a professor of respiratory medicine at the University of Modena and Reggio Emilia in Modena, Italy.
There is a place for both drugs and even using both together, Fabbri noted. "Guidelines recommend the use of both medications when one is deemed not to be adequately effective," he said. "But this recommendation is based on little evidence. Usually, we have to add an inhaled steroid instead of another bronchodilator."
Fabbri also pointed out that neither drug cures COPD or slows its progression. "These are purely drugs [that treat symptoms]," he said.
The study was funded by Boehringer Ingelheim and Pfizer, the makers of Spiriva. Spiriva can cost over $200 a month, but a generic is available for around $30 to $40 a month, and it is also covered by Medicare. Serevent, made by GlaxoSmithKline, can cost over $100 a month, depending on the dose and how the medication is delivered, and is also covered by Medicare drug plans.
Dr. Jadwiga A. Wedzicha, a professor of respiratory medicine at University College London Medical School of University College London in the United Kingdom and author of an accompanying journal editorial, said that a bronchodilator "is really just the start of treatment."
Many COPD patients will
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