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Tiotropium versus salmeterol in COPD.

To the Editor: The article on the Prevention of Exacerbations with Tiotropium in COPD (POET-COPD) trial (ClinicalTrials.gov number, NCT00563381) by Vogelmeier et al. (March 24 issue)1 provides valuable information on choosing between inhaled therapies to prevent exacerbations in moderate-to-very-severe chronic obstructive pulmonary disease (COPD). However, the high prevalence of smoking among subjects in the trial (48% of the subjects were current smokers) highlights the continued importance of smoking cessation. Stopping smoking with pharmacotherapy2 is the only treatment, other than long-term oxygen therapy,3 proved to reduce mortality in COPD, and it has also been shown to be a treatment with a much higher value than inhaled therapy, when outcome is considered relative to cost.4,5 It is remarkable, given the high continuing smoking prevalence among patients with COPD exemplified by this study, that the effect of smoking-cessation interventions on morbidity still awaits a trial. The study that is needed is an evaluation of smoking-cessation interventions involving effective outcome measures of morbidity as in the POET-COPD trial. Meanwhile, one of the outcome measures we, as clinicians, should be judged on is the reduction of the prevalence of smoking among our patients with COPD.