HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (51) Citing Articles via Google Scholar Google Scholar Articles by Tashkin, D. Articles by Kesten, S. Search for Related Content PubMed PubMed Citation Articles by Tashkin, D. Articles by Kesten, S.

Long-term Treatment Benefits With Tiotropium in COPD Patients With and Without Short-term Bronchodilator Responses^*

^* From the Pulmonary Division (Dr. Tashkin), David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA; and Boehringer Ingelheim Pharmaceuticals, Inc (Dr. Kesten), Ridgefield, CT.

Correspondence to: Donald Tashkin, MD, FCCP, David Geffen School of Medicine at UCLA, Pulmonary Division, CHS Rm 37–131, 10833 Le Conte Ave, Los Angeles, CA 90095-3075; e-mail: DTashkin{at}mednet ucla.edu

Objectives: To determine whether long-term symptomatic improvement occurs in COPD patients with maintenance bronchodilator therapy despite a nonsignificant short-term improvement in FEV₁ following bronchodilator inhalation obtained at a single time point.

Methods: Data obtained during two identical 1-year, placebo-controlled trials of tiotropium, 18 µg once daily, were analyzed retrospectively to determine the associations of long-term improvements in lung function and patient health status with short-term improvements in FEV₁, as measured on the first day of treatment. Based on the presence or absence of a short-term improvement in FEV₁ of 12% and 200 mL, respectively, patients who had been treated with tiotropium were characterized as being responsive to tiotropium (TIO-R) or poorly responsive to tiotropium (TIO-PR).

Results: Baseline characteristics were similar other than baseline FEV₁, which was higher in the TIO-R group than in both the TIO-PR and placebo groups (p < 0.05). Baseline FEV₁ was 1.08 L in the TIO-R group (n = 263), 0.95 L in the TIO-PR (n = 255), and 0.99 L in the placebo group (n = 328). The mean (± SD) morning predose FEV₁ at 1 year significantly (p < 0.001) improved in patients in both of the tiotropium treatment subgroups (TIO-R group, 212 ± 17 mL; TIO-PR group, 94 ± 17 mL) relative to those treated with placebo. Statistically significant improvements in both tiotropium-treated groups also were noted over 1 year for dyspnea (p < 0.001), as assessed by the transition dyspnea index (TDI) [TIO-R group, 1.36 ± 0.23 L; TIO-PR group, 0.86 ± 0.23 L] relative to the placebo group. Patient health status assessed by the St. George Respiratory Questionnaire (SGRQ) showed statistically significant improvements over placebo for the TIO-R and TIO-PR groups (-3.96 ± 0.99 and -3.05 ± 1.00 L, respectively; p < 0.005). There was a significant correlation of the first-dose short-term FEV₁ response to the end-of-trial trough response (r = 0.43), but there was only a weak correlation to TDI focal score (r = 0.17) or SGRQ total score (r= -0.12).

Conclusions: Tiotropium was effective in the treatment of patients with COPD, irrespective of the presence or absence of a short-term response on the first day of treatment. The short-term bronchodilator response should not be used as a definitive criterion for prescribing long-term treatment with inhaled bronchodilators.

Key Words: COPD • dyspnea • exacerbations • quality of life • spirometry • tiotropium

This article has been cited by other articles:

				R G Barr, J Bourbeau, C A Camargo, and F S F Ram Tiotropium for stable chronic obstructive pulmonary disease: a meta-analysis Thorax, October 1, 2006; 61(10): 854 - 862. [Abstract] [Full Text] [PDF]

				H. Somand and T. L Remington Tiotropium: A Bronchodilator for Chronic Obstructive Pulmonary Disease Ann. Pharmacother., September 1, 2005; 39(9): 1467 - 1475. [Abstract] [Full Text] [PDF]

				N. J. Gross Tiotropium Bromide Chest, December 1, 2004; 126(6): 1946 - 1953. [Abstract] [Full Text] [PDF]

				S.K. Jindal Dutch Hypothesis: Revisited? Chest, August 1, 2004; 126(2): 329 - 331. [Full Text] [PDF]

				D.-W. Perng, H.-Y. Huang, H.-M. Chen, Y.-C. Lee, and R.-P. Perng Characteristics of Airway Inflammation and Bronchodilator Reversibility in COPD: A Potential Guide to Treatment Chest, August 1, 2004; 126(2): 375 - 381. [Abstract] [Full Text] [PDF]

				W.T. McNicholas, P.M.A. Calverley, A. Lee, and J.C. Edwards Long-acting inhaled anticholinergic therapy improves sleeping oxygen saturation in COPD Eur. Respir. J., June 1, 2004; 23(6): 825 - 831. [Abstract] [Full Text] [PDF]

				A. Hasani, N. Toms, J. E. Agnew, M. Sarno, A. J. Harrison, and P. Dilworth The Effect of Inhaled Tiotropium Bromide on Lung Mucociliary Clearance in Patients With COPD Chest, May 1, 2004; 125(5): 1726 - 1734. [Abstract] [Full Text] [PDF]

				N J Gross Responses to steroids and bronchodilators in COPD in the ISOLDE trial: the fat lady sings on Thorax, August 1, 2003; 58(8): 647 - 648. [Full Text] [PDF]

				Long-Term Response to Tiotropium, an Anticholinergic Bronchodilator for COPD Journal Watch (General), May 27, 2003; 2003(527): 1 - 1. [Full Text]

eLetters: