Decision Resources, Waltham, Mass, finds that despite its higher cost, Boehringer Ingelheim/Pfizer’s anticholinergic, Spiriva, consistently leads both GlaxoSmithKline’s Serevent and Astellas/Schering-Plough/Novartis’s Foradil by a wide margin in first-, second-, and third-line therapy for moderate COPD. All three of these long-acting, single-agent bronchodilators are recommended for use as first-line maintenance treatment of moderate COPD.

According to the new report titled “Treatment Algorithms in COPD,” although pulmonologists and COPD guidelines recommend Spiriva as first-line maintenance therapy for patients with moderate COPD, Advair is more widely used in every line of therapy. The report also showed that primary care physicians have divided opinions when choosing between the two drugs.

“Interviewed thought leaders believe that many primary care physicians turn to Advair in early lines of therapy in COPD because of their familiarity with inhaled corticosteroids in treating asthma,” said Madhuri Borde, PhD, analyst at Decision Resources. “However, Spiriva does have its advantages as many specialists and primary care physicians rank Spiriva’s greater improvement of lung function as a primary reason for choosing it over Advair. We also found that more primary care physicians than pulmonologists indicated that Spiriva’s ability to decrease exacerbations is a primary reason to choose the anticholinergic over Advair.”