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This Article Full Text (PDF) Free All Versions of this Article: chest.06-3059v1 132/5/1493    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal 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 Google Scholar Google Scholar Articles by Kerstjens, H.A.M. Articles by Cornelissen, P.J.G. Search for Related Content PubMed PubMed Citation Articles by Kerstjens, H.A.M. Articles by Cornelissen, P.J.G.

Short-acting bronchodilators added to maintenance tiotropium therapy

¹University Medical Center Groningen, Groningen ²Amphia Hospital, Breda ³Gelre Hospitals, Zutphen ⁴Hospital Group Twente, Almelo ⁵Sint Lucas Hospital, Winschoten ⁶Boehringer Ingelheim bv, Alkmaar, The Netherlands

h.a.m.kerstjens{at}int.umcg.nl

Abstract

BackgroundCombining bronchodilators has been shown to be beneficial in chronic obstructive pulmonary disease (COPD). The additive effects of short-acting bronchodilators added to maintenance tiotropium therapy, however, are unknown.

MethodsFollowing 3-week tiotropium pre-treatment, 60 patients with COPD (FEV₁ 40% predicted) participated in a randomized, placebo-controlled study to assess add-on bronchodilator effects of ipratropium bromide (40 µg) or fenoterol (200 µg). The short-acting bronchodilators were added as a single dose 2 and 8 h after tiotropium dosing. Serial lung function tests were performed over 9 h.

ResultsThe peak FEV₁ add-on response within six hours with fenoterol was significantly greater than with placebo (137 mL) or ipratropium (84 mL); the response with ipratropium was slightly but significantly larger than with placebo (52 mL). One hour after the second dose of the test drugs a similar order of treatment responses was found. The peak FVC add-on response was significant for fenoterol (249 mL) but not for ipratropium (42 mL).

ConclusionsIn conclusion, both short-acting bronchodilator classes were effective when added to maintenance treatment with tiotropium. The addition of the ß₂-adrenergic fenoterol provided greater additional bronchodilatation than the short-acting anticholinergic ipratropium. This is consistent with the expected effects of combining bronchodilators with different pharmacological mechanisms.

This randomized controlled trial was registered at www.clinicaltrials.gov (NCT00274066)

Key Words: chronic obstructive pulmonary disease • fenoterol • ipratropium bromide • short-acting bronchodilators • tiotropium