[The effect of salmeterol in the treatment of smokers with chronic obstructive lung disease].

Patients with chronic obstructive pulmonary disease (COPD) may benefit from long term treatment with bronchodilators despite having a modest acute response to these drugs. To investigate the efficacy of salmeterol in smokers with COPD a double blind, randomised, crossover comparison was performed between salmeterol (50 micrograms twice daily) and placebo in 63 patients with stable COPD (mean age 63 yrs); inclusion criteria: aFEV1) < 60% of predicted and FEV1 reversibility < 15% (0.4 mg salbutamol). Patients received four weeks of therapy with each of the treatment regimens. Assessment of efficacy was done by recording morning and evening peak expiratory flow rates (PEF), respiratory symptoms, and use of rescue salbutamol. Morning PEF values were higher during the salmeterol than during the placebo period, although the mean treatment difference was small (12 l/min (95% confidence limits 6 to 17)). No difference in mean evening PEF values was found. Diurnal variation in PEF was more pronounced during the placebo than during the salmeterol period. Compared with placebo, treatment with salmeterol was associated with lower day time and night time symptom scores and less use of rescue salbutamol both during the day and the night. This study shows that, compared with placebo, treatment with salmeterol produces an improvement in respiratory symptoms and morning PEF values in patients with moderate to severe COPD. Treatment with long acting beta(2)-agonists may therefore result in an improvement in functional status, even in patients suffering from apparently non-reversible obstructive pulmonary disease.