The Pharmaceutical Journal
Vol 269 No 7215 p351
14 September 2002

This article
Reprint
Photocopy

News summary

New therapy an "advance" in COPD but role in practice needs defining

A new inhaled therapy for chronic obstructive pulmonary disease (COPD) has a place in treatment for the "vast majority" of patients, according to a consultant respiratory physician.

Tiotropium (Spiriva), a long acting anticholinergic bronchodilator, developed specifically for use in COPD, was launched on 5 September (see p357). However, the benefits of tiotropium seen in clinical trials will need to be confirmed before its place in clinical practice can be defined.

At a press briefing held in London last week, Dr Michael Rudolf, Ealing Hospital, London, said that the new inhaler would be an "undoubted advance" for those COPD patients who needed regular bronchodilators, giving them better control of their disease. That meant the vast majority of COPD patients in both primary and secondary care, he added.

Katrina Simister, new product manager, National Prescribing Centre, Liverpool, told The Journal: "Tiotropium is an interesting development, particularly if the slowing in FEV1 decline seen in clinical trials is confirmed in practice. In addition, whether the reductions in exacerbations and hospital admissions reported as secondary endpoints in trials are seen in practice will be crucial to defining its role."

Professor Paul Corris, department of thoracic medicine, University of Newcastle-upon-Tyne, said at the briefing that he saw tiotropium being used initially as an add-on treatment, given with baseline therapy. He commented that interesting data on combination therapy with tiotropium and long-acting beta-agonists was developing. COPD patients with daily symptoms and breathlessness as the principal symptom deserved a trial of tiotropium, he said.

Tiotropium is the first once-daily, inhaled bronchodilator for COPD. It acts by blockade of the M3 receptors in the airways, which play a pivotal role in the smooth muscle contraction of COPD.

Trials have shown that tiotropium can improve lung function in COPD in studies against placebo, ipratropium and salmeterol, and that it can effectively reduce breathlessness — regarded as the most disabling symptom of COPD. A 47 per cent reduction in hospital admissions was seen in a trial of tiotropium versus placebo.

Chris Fehrenbach, senior respiratory nurse specialist, Portsmouth NHS Trust, commented that the new inhaler device for tiotropium, the HandiHaler, had the lowest flow requirement for a dry powder inhaler, making it suitable for COPD patients with poor airflow. Patients insert a capsule into the inhaler, press a button to pierce it, and inhale, with vibration of the capsule indicating sufficient flow. She said that compliance with the device had been good in trials.