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(Chest. 2004;125:1726-1734.)
© 2004 American College of Chest Physicians

The Effect of Inhaled Tiotropium Bromide on Lung Mucociliary Clearance in Patients With COPD*

Amir Hasani, PhD; Nathan Toms, MSc; John E. Agnew, PhD; Maria Sarno, MD; Aleck J. Harrison, BSc and Paul Dilworth, DM

* From the Departments of Medical Physics (Drs. Hasani and Agnew) and Thoracic Medicine (Mr. Toms and Dr. Dilworth), Royal Free Hampstead NHS Trust and Royal Free and University College Medical School, London; and Boehringer Ingelheim Ltd. (Dr. Sarno and Mr. Harrison), Bracknell, Berkshire, UK.

Correspondence to: Amir Hasani, PhD, Department of Medical Physics, Royal Free Hospital, Pond Street, London, UK, NW3 2QG; e-mail: amer.alhasani{at}royalfree.nhs.uk

Study objective: To assess the effects of tiotropium on lung mucociliary clearance in COPD.

Design: Randomized, double-blind, placebo-controlled, parallel-group study.

Setting: Outpatients of an urban-area university teaching hospital.

Patients: Thirty-four patients with COPD aged 40 to 75 years classified equally into two groups.

Intervention: Single (18 µg) daily dose of tiotropium inhalation capsules or of placebo for 21 days.

Methods: Six-hour tracheobronchial clearance of inhaled 99mTc-labeled polystyrene particles using a 48-h retention measurement to determine the "nontracheobronchial" deposition fraction.

Results: Test radioaerosol penetration into the lungs increased significantly (p < 0.003) as did FEV1 (p < 0.006) in the tiotropium-treated patients, but measured mucociliary clearance was not significantly changed despite the increased pathway length for clearance (mean ± SE area under the tracheobronchial retention curve changed from 442 ± 22 to 453 ± 20%/h). Smaller (nonsignificant) decreases of radioaerosol penetration and FEV1 occurred in the placebo group together with a small (nonsignificant) decrease in the area under the retention curve.

Conclusion: Twenty-one days of inhaled tiotropium, 18 µg/d, as a dry powder does not retard mucus clearance from the lungs.

Key Words: anticholinergic • COPD • mucociliary clearance • radioaerosol • tiotropium




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R G Barr, J Bourbeau, C A Camargo, and F S F Ram
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