Pneumologie 2017; 71(S 01): S1-S125
DOI: 10.1055/s-0037-1598311
Posterbegehung – Sektion Klinische Pneumologie
COPD I – Andreas Rembert Koczulla/Marburg, Henrik Watz/Großhansdorf
Georg Thieme Verlag KG Stuttgart · New York

Analysis of Rescue Medication Use over 1 Year in Patients Receiving LAMA, LABA, or Combination Maintenance Treatment for COPD in the TONADO Studies

R Abrahams
1  Morgantown Pulmonary Associates
GT Ferguson
2  Pulmonary Research Institute of Southeast Michigan, Farmington Hills
E Clerisme Beaty
3  Boehringer Ingelheim Pharmaceuticals, Inc.
F Voss
4  Boehringer Ingelheim Pharma GmbH and Co. KG
R Buhl
5  Pulmonary Department, Mainz University Hospital
› Author Affiliations
Further Information

Publication History

Publication Date:
23 February 2017 (online)



In this analysis, we assessed the effect of prolonged use of a SABA (full agonist) as rm over time by comparing the rate of albuterol use (a) in the absence of a LABA (t) and when combined with LABA maintenance treatment (o or t+o).


5162 patients were randomized to once-daily t+o 2.5/5 or 5/5 mcg, t 2.5 or 5 mcg, or o 5 mcg, via the Respimat®, in 2 52-week, double-blind, parallel-group studies (NCT01431274; NCT01431287). Patients received a SABA inhaler (salbutamol/albuterol) for rm, as needed, and recorded the number of puffs used in an e-diary. We analyzed, post hoc, the mean yearly rates of change in daytime, nighttime, and daily (24-hour) SABA use using data combined from both studies.


Daily use of SABA rm increased over 1 year in patients receiving t by (mean [95% CI]) 0.49 (0.32, 0.65) daily puffs/year with t 5 mcg and 0.30 (0.13, 0.47) daily puffs/year with t 2.5 mcg. SABA use increased to a lesser extent with o 5 mcg: 0.22 (0.05, 0.39) daily puffs/year and was relatively unchanged with t+o 5/5 mcg: 0.15 (-0.02, 0.32) daily puffs/year and t+o 2.5/5 mcg: -0.01 (-0.18, 0.16) daily puffs/year. The rate of change in SABA use was significantly greater with t versus t+o and with t 5 mcg versus o. However, there was no significant difference in the yearly rate of change in SABA use in patients receiving o compared to those on t+o.


Patients using SABA rm alongside daily LAMA with t had an increase in SABA use over 1 year compared to those using SABA rm in addition to LABA or LAMA/LABA combination treatment. Given the established long-term efficacy profile of t, these findings suggest that prolonged unopposed use of a SABA without the partial agonist effects of LABA treatment may lead to tachyphylaxis and increased SABA use over time.

Content already presented at ATS congress 2016