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Background The bronchodilator response to short-acting β 2 -agonist and short-acting muscarinic antagonist monotherapies varies on a day-to-day basis within individual patients. The objective of this study was to compare daily variation in bronchodilator response to the combined use of albuterol and ipratropium with monotherapies in patients with chronic obstructive pulmonary disease (COPD). Methods This was a 4-week, randomized, open-label, two-period crossover study in patients with COPD. Patients were randomized 1:1 to receive albuterol via metered dose inhaler followed by ipratropium or vice versa during treatment Period 1 (10–14 days). The order of treatments was then reversed during treatment Period 2 (10–14 days). Pre-defined efficacy endpoints were: forced expiratory volume in 1 s (FEV 1 ), derived FEV 1 , inspiratory capacity (IC) and daily variability of FEV 1 and IC as measured by coefficient of variation (CV). Results Albuterol and ipratropium improved FEV 1 when administered as the first bronchodilator, compared with pre-dose values (0.269 and 0.243 L, respectively). Administration of the second bronchodilator provided further improvements in lung function, but to a lesser magnitude than the first bronchodilator (0.094 L for both treatments). A statistically significant reduction in daily variability in FEV 1 was observed for dual bronchodilator therapy compared with monotherapy (difference in CV = 0.007; p = 0.019) and pre-dose values (no treatment; difference in CV = 0.022; p < 0.001). Conclusions The free combination of albuterol and ipratropium resulted in greater improvements and lower day-to-day variability in FEV 1 compared with either monotherapy or no bronchodilator therapy. The reduced daily variability may be an important therapeutic advantage of using different classes of bronchodilators in COPD. Trial registration NCT01691482 . [ABSTRACT FROM AUTHOR]

Background: Combination long-acting bronchodilator therapy may be more effective than long-acting bronchodilator monotherapy in chronic obstructive pulmonary disease (COPD).Objectives: To compare the efficacy and safety of once-daily umeclidinium/vilanterol (UMEC/VI) 125/25 mcg with placebo and UMEC or VI monotherapy in COPD.Methods: This was a double-blind, placebo-controlled, parallel-group study. A total of 1493 patients were randomized (3:3:3:2) to 24 weeks of treatment with UMEC/VI 125/25 mcg, UMEC 125 mcg, VI 25 mcg, or placebo once-daily via dry powder inhaler.Results: Primary efficacy endpoint was trough forced expiratory volume in one second (FEV1) on Day 169 (23-24 h post-dose). Additional lung-function, symptomatic and health-related quality of life endpoints were also assessed. Safety evaluations included: adverse events, vital signs, electrocardiography and clinical laboratory measurements. All active treatments significantly improved trough FEV1 vs placebo (0.124-0.238 L, all p<0.001). Improvements with UMEC/VI 125/25 mcg were significantly greater than for UMEC 125 mcg or VI 25 mcg (0.079 L and 0.114 L; both p≤0.001). Improvements for UMEC/VI 125/25 mcg vs placebo were observed for the transition dyspnea index (1.0 unit; p<0.001), rescue albuterol use at Weeks 1-24 (-1.5 puffs/day) and St. George's Respiratory Questionnaire (-3.60 units, p<0.001). No safety signals were observed.Conclusions: Once-daily UMEC/VI 125/25 mcg was well tolerated and provided greater improvements in lung function, health status, and dyspnea scores compared with monotherapy components and placebo over 24 weeks. This study supports the use of UMEC/VI 125/25 mcg for the maintenance treatment of COPD.Clinical Trial Registration: protocol number: DB2113361; ClinicalTrials.gov identifier: NCT01313637. [ABSTRACT FROM AUTHOR]

The article examines the effect of fluticasone propionate/salmeterol (FSC 250/50) on lung hyperinflation and exercise endurance in chronic obstructive pulmonary disease (COPD) patients. Predose and postdose spirometry, plethysmography and constant-load cycle cardiopulmonary exercises test evaluations have been compared. It was found that FSC 250/50 significantly reduced postdose functional residual capacity and increased inspiratory capacity compared with placebo.