Background and objectives: COPD is a major public health problem worldwide. Over the past few decades, spectrum of pharmacological therapy in COPD has expanded and more objective and optimistic picture is evolving. Now this is the time to explore the effectivity of available COPD medications for more cost effective management.

Methods: Thirty moderate degree COPD patients who volunteered and completed washout period of two weeks showing clinical stability, were allocated in two groups through randomization. Group–1 received inhaled Formoterol (LABA/ Long acting beta agonist) while Group–2 had Tiotropium (LAMA/ Long acting muscarinic antagonist). Inhaled Budesonide (ICS/ inhaled corticosteroid) was given to all patients beside LABA or LAMA. Patients were assessed for six weeks with testing sequence of Pulmonary Function Test and CAT (COPD Assessment Test) score at visit–1 (day ‘0’i.e, the day of start of the therapy), visit–2 (day ‘21’) and visit–3 (day ‘42’).

Results: 77% patients were male and 23% female, while 70% was smokers and 30% non smokers. In Group–1 (LABA) patients, significant improvement of FEV₁, FVC, FEF_25–75%,CAT score was noted (p–value<0.05) in visit 2, 3 and PEFR in visit–3 (p–value=0.05), but no significant improvement of FEV₁/FVC. In Group–2 (LAMA) patients, there was gradual improvement of FEV₁, FEF_25–75% and CAT score in visit 2, 3 (p–value<0.05), significant betterment of FVC, FEV₁/FVC and PEFR in visit–3.

Conclusion: We conclude that in management of moderate COPD, both Formoterol (LABA) and Tiotropium (LAMA) are almost equally effective in improvement of spirometric parameters and symptom scorebeside Budesonide (ICS). However, Formoterol+ ICS may be more user–friendly as available in a single canister compared to Tiotropium+ICS.