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    Study: Spiriva Beats Serevent for COPD Flare-ups

    Drug Is More Effective at Preventing Flare-ups of Chronic Pulmonary Obstructive Disease

    Choosing a COPD Drug continued...

    Tiotropium is not available in combination with an inhaled steroid, but salmeterol is, he says. If someone also needs steroids, the latter may be a better option as it is simpler to administer.

    Thomas Aldrich, MD, professor of medicine at Montefiore Medical Center and the Albert Einstein College of Medicine in the Bronx, N.Y., has always favored Spiriva over Serevent.

    “It as good with fewer side effects,” he says. The new study does help narrow the playing field, he says.

    “There is a tendency to use many drugs to treat COPD, and each one has potential side effects and costs a fortune, so if we can make a more rational choice and cut down to the ones that are most likely to be effective, it will be of tremendous benefit,” he says.

    Personalized Therapy for COPD

    Barry Make, MD, a pulmonologist and professor of medicine at National Jewish Health in Denver, says that the new findings may tip the scale toward starting select people with COPD on Spiriva as opposed to other long-acting bronchodilators.

    But there is more to it, he says. “I look at each patient as an individual and make treatment decisions based on their particular characteristics and symptoms," he says. “If your goal is to decrease exacerbations in someone who is prone to them, Spiriva may be the right choice. But for someone who doesn’t have so many exacerbations, we may focus on symptoms instead and choose another drug.”

    Len Horovitz, MD, an internist and pulmonologist at Lenox Hill Hospital in New York City, says there is more to COPD management than simply increasing time to first exacerbation.

    “This is just one parameter,” he says. Others include long-term survival or disease progression and the new study does not look at these.

    “It is important to have [Spiriva] on board, but it’s not the only drug that you would want to have on board,” he says.

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