Review: long-acting beta2-adrenoceptor agonists are effective in poorly reversible chronic obstructive pulmonary disease.

M e t h o d s Data sources: MEDLINE, EMBASE/ Excerpta Medica, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Airways Group Specialised Register (to July 2005), online registries of published and unpublished clinical trials, lists of conference abstracts, and bibliographies of relevant studies. Study selection and assessment: Randomized controlled trials (RCTs) that compared inhaled LABAs (salmeterol or formoterol) given for ≥ 4 weeks with placebo in patients who had stable, moderately severe COPD without asthma; FEV1≤ 75% or FEV1/FVC ≤ 70% of predicted value; poor reversibility after short-dose short-acting β2-agonist (≤ 15% reversibility of FEV1 from baseline or as a percentage of predicted normal value); and no infections, exacerbations, or hospitalizations in the past month. Individual study quality was assessed using the 5-point Jadad scale. 23 RCTs (n = 6061, mean age range 58 to 72 y) met the selection criteria and had Jadad scores between 3 and 5. Outcomes: Lung function (FEV1, FVC, and PEF), exercise tolerance, quality of life (St. George’s Respiratory Questionnaire [SGRQ] or Chronic Respiratory Diseases Questionnaire [CRDQ]), dyspnea (transition dyspnea index [TDI]) and symptoms, exacerbations, use of rescue medication, and withdrawals.