Long‐acting beta2‐agonists versus long‐acting muscarinic antagonists in patients with stable COPD: A systematic review and meta‐analysis of randomized controlled trials

ABSTRACT Several long‐acting bronchodilators have been developed and are widely used as first‐line treatment in patients with stable chronic obstructive pulmonary disease ( COPD ). However, the initial choice of therapy is still uncertain. The aim of this study was to examine the clinical efficacy and safety of long‐acting muscarinic antagonist ( LAMA ) and long‐acting beta2‐agonist ( LABA ) in patients with stable COPD . We searched several databases and manufacturers’ websites to identify relevant randomized clinical trials for meta‐analysis. Outcomes of interest were trough forced expiratory volume in 1 s ( FEV 1 ), acute exacerbations, transitional dyspnoea index ( TDI ) score, St George's Respiratory Questionnaire ( SGRQ ) score and adverse events. Sixteen trials with a total of 22 872 patients were included in this study. Compared with LABA , LAMA were associated with a greater reduction in acute exacerbations ( OR : 0.84, 95% CI : 0.74–0.94, P = 0.003) and fewer adverse events ( OR : 0.92, 95% CI : 0.86–0.97, P = 0.005). There were no significant differences in trough FEV 1 , TDI and SGRQ scores. In patients with stable COPD , LAMA were associated with a greater reduction in acute exacerbations and fewer adverse effects compared with LABA .