Clinical Reviews in Allergy & Immunology

, Volume 31, Issue 2, pp 219-230

First online:

Systematic review of clinical outcomes in chronic obstructive pulmonary disease

β-Agonist use compared with anticholinergics and inhaled corticosteroids
  • Shelley R. SalpeterAffiliated withDepartment of Medicine, Stanford University School of MedicineSanta Clara Valley Medical Center Email author 
  • , Nicholas S. BuckleyAffiliated withInternational Baccalaureate Program, Sequoia High School

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Much controversy surrounds the use of β-agonists in obstructive lung disease. Regular β2-agonist use in asthma results in tolerance to its effects and an increase in asthma-related deaths. Less is known about clinical outcomes in chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis evaluates the long-term effect of β2-agonist use on severe exacebations requiring hospitalization or trial with drawal, respiratory deaths, and total mortality in patients with COPD. Results for β2-agonists are compared with results for anticholinergics and inhaled corticosteroids. Pooled results from randomized controlled trials show that anticholinergics, such as tiotropium and ipratropium, significantly reduce severe exacerbations and respiratory deaths compared with placebo. Conversely, β2-agonists increase respiratory deaths, probably because of tolerance that develops to their bronchodilator and bronchoprotective effects. Anticholinergics significantly reduce exacerbations and total mortality compared with β-agonists. The combination of the two bronchodilators is not more effective than anticholinergics alone in improving long-term clinical outcomes. Inhaled corticosteroids significantly reduce severe exacerbations and the decline in lung function over time, without affecting mortality. In conclusion, inhaled anticholinergic bronchodilators and corticosteroids should be used to improve long-term clinical outcomes in patients with COPD. β-Agonists increase respiratory deaths in COPD, possibly as a result of poorer disease control.

Index Entries

Chronic obstructive pulmonary disease adrenergic β-agonists cholinergic antagonists corticosteroids meta-analysis clinical outcomes mortality