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Am Fam Physician. 2001;64(4):661

Chronic obstructive pulmonary disease (COPD) is presently the fourth leading cause of death in the United States, and it continues to become more prevalent. Current treatment guidelines suggest that as COPD progresses, it is appropriate to prescribe ipratropium bromide and an inhaled beta2 agonist. A combined formulation of ipratropium and albuterol is now available in a metered-dose inhaler. This combination simplifies the treatment regimen, which may improve compliance. One concern, however, is the possibility of increased and unnecessary medication use. Benayoun and colleagues studied the impact of combined inhaled bronchodilators in the treatment of COPD.

All patients in a Canadian province who received ipratropium and a beta2 agonist in one inhaler or who received the medications in separate inhalers were enrolled in the study. The primary outcome was the use of inhaled bronchodilators, other respiratory medications and selective antibiotics during the one-year study period. Costs related to the use of bronchodilators were also recorded.

Patients who were treated with the fixed combination of ipratropium and beta2 agonist were found to have slightly elevated use of inhaled bronchodilators. However, overall costs associated with the bronchodilators were lower in the patients who used the fixedcombination inhaler. Rates of use for other respiratory drugs and antibiotics were similar in patients using combined inhaled bronchodilators and those using each medication separately. The estimated annual cost savings for using the fixed-combination inhaler exceeded $100,000 in Canadian dollars.

Benayoun and colleagues concluded that using the combined ipratropium and beta2 agonist metered-dose inhaler did not significantly alter the treatment regimen in COPD patients. However, use of the fixed-combination inhaler did result in appreciable savings. This savings occurred despite the fact that the fixed-combination product costs more per inhaler than the two inhaled agents purchased separately.

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