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Which medications work best for older adults with chronic obstructive pulmonary disease?

Doctors aren’t entirely sure: Despite the fact that C.O.P.D. is the third-leading cause of death, there is scant research on the comparative effectiveness of treatment options in seniors. But a study recently published in The Journal of the American Medical Association provides valuable new information.

C.O.P.D. refers primarily to two conditions that compromise breathing: emphysema and chronic bronchitis. Nearly four million seniors have been diagnosed with the condition.

For their new study, researchers in Ontario combed through records of all adults ages 66 and older with C.O.P.D. who had started taking two types of medications: long-acting beta agonists and inhaled corticosteroids.

Long-acting beta agonists (sold under brand names like Foradil, Oxis, Serevent) help relax muscles around the airways in the lungs, allowing air to flow more freely. Inhaled corticosteroids (Flovent, Azmacort, Asmanex and others) act against inflammation and swelling in airways, making breathing easier.

Clinical guidelines recommend that doctors begin treatment for C.O.P.D. with long-acting beta agonists (or another set of medications called long-acting anticholinergics, not studied in this report), then add other medications if necessary. But it has never been clear if this is optimal for older adults.

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