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Campbell's recent article¹ in the ARCHIVES demonstrated that the use of scheduled dosing with the combination product ipratropium bromide and albuterol sulfate (Combivent) is more effective in patients with chronic obstructive pulmonary disease (COPD) than scheduled albuterol base alone. This finding is not surprising, nor should it change the way one manages patients with COPD. The American Thoracic Society and the National Lung Health Education Program advocate scheduled dosing with ipratropium as initial therapy for patients with COPD who have mild to moderate continuing symptoms.^2-3 Albuterol is recommended concomitantly with ipratropium on an as-needed basis for symptomatic relief, or as scheduled dosing when a patient requires continuous treatment.

To evaluate the clinical role of the combination product ipratropium-albuterol in COPD, the investigators should have included additional treatment arms such as scheduled ipratropium alone, scheduled ipratropium with intermittent albuterol, or both groups. One could argue that this combination product provides sufficient . . . [Full Text of this Article]