Not all COPD medications are created equal

Toronto – Chronic Obstructive Pulmonary Disease (COPD) is the 4th most common cause of death in Canada and affects an estimated 12 to 20 per cent of the adult population. In Ontario alone, more than 700,000 adults over the age of 35 live with this disease. Medications are a mainstay of COPD management but according to new research conducted at the Institute for Clinical Evaluative Sciences (ICES) there are significant differences in the effectiveness of these medications.

“Our work suggests that choosing one specific COPD medication over another may save lives as well as decrease hospitalizations and emergency department visits. But these results should be confirmed in other studies before they are applied in practice or policy,” says principal investigator, ICES Scientist and respirologist, Dr. Andrea Gershon.

COPD is a chronic, progressive respiratory disease that can be prevented mainly by decreasing the rate of smoking. Once someone has COPD,it is incurable but symptoms and other health outcomes can be improved with treatment. There are two types of inhaled, long-acting medications–β-agonists (like salmeterol and fomerterol) and anticholinergics (like tiotropium)–that have both been shown to improve COPD outcomes; however, it was not known which was more effective.

The population-based cohort study examined more than 46,000 individuals with COPD between 2003 and 2007 and found that (after adjusting for a number of demographic and clinical factors) individuals initially prescribed long-acting anticholinergics were more likely to have poor health outcomes than those initially prescribed long-acting β -agonists, specifically they were:

  • 14 per cent are more likely to die.  This corresponded to an unadjusted increase in mortality of 2.4 per cent or a decrease in time to death of about 3 months.
  • 13 per cent more likely to be hospitalized for COPD. This corresponded to an unadjusted absolute increase in hospitalization of 2.6 per cent or a decrease in time to first hospitalization of just over 3 months.
  • 9 per cent more likely to visit the emergency department for COPD.  This corresponded to an unadjusted absolute decrease in emergency department visits of 0.5 per cent or a decrease in time to emergency department visit of almost 3 months.
  • Also more likely to be hospitalized or visit the emergency department for conditions that can be exacerbated by COPD such as pneumonia, influenza, and heart disease

“Our study examined older people taking these two classes of medication and found that those taking β-agonists tended to live longer, were less likely to need hospitalization, and were less likely to visit the emergency department. Such information would allow physicians to recommend and patients to use the medication most likely to provide the greatest survival benefit and avoid hospitalizations, emergency department visits and the need for additional medications with their own risks, inconvenience, and cost,” says Gershon.

Authors: Andrea Gershon, MD, MSc; Ruth Croxford, MSc, PStat; Teresa To, PhD; Matthew B. Stanbrook, MD, PhD; Ross Upshur, MD, MSc; Paula Sanchez-Romeu, BMath, MMath; and Thérèse Stukel, PhD.

The study “Comparison of Long-Acting Inhaled β-Agonist and Anticholinergic Effectiveness in Older Patients With Chronic Obstructive Pulmonary Disease:  A Cohort Study,” is in the May 3, 2011 issue of the Annals of Internal Medicine.

More detailed study findings on the ICES website:

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


Deborah Creatura
Media Advisor, ICES
[email protected]
416-480-4780 or cell 647-406-5996