Tiotropium reduces exacerbations in COPD
The long-acting anticholinergic tiotropium (Spiriva) reduces the frequency of chronic obstructive pulmonary disease (COPD) exacerbations and associated hospital admissions, a study reported at the American
Thoracic Society annual conference held in Orlando, Florida, last month reveals.
The study randomised 1,829 patients with moderate-to-severe COPD to treatment
with once-daily tiotropium (914 patients) or placebo (915 patients) on
top of their existing therapy, including bronchodilators and inhaled
corticosteroids but excluding other anticholinergic agents.
Results showed that tiotropium reduced exacerbations by nearly 20 per
cent, with 27.9 per cent of the patients randomised to the drug suffering
at least one exacerbation during a six-month follow-up compared with
32.3 per cent of the placebo group (P=0.037). Exacerbations were defined
as an increase in at least two symptoms (including cough, sputum, wheezing,
dyspnoea or chest tightness) for at least three days, associated with
a need for increased treatment or hospital admission. Nearly one in 10
patients (9.5 per cent) randomised to placebo had at least one admission
during the six months of the study, compared with 7.0 per cent of those
treated with tiotropium (P=0.056).
Reporting the results, lead investigator Dennis Niewoehner, professor
of medicine, University of Minnesota, Minneapolis, added: “COPD
exacerbations are extremely debilitating, and may be life-threatening.
Frequent exacerbations may even accelerate COPD progression.” On
average, COPD patients suffer one or two exacerbations every year.
A further study presented at the conference showed that tiotropium reduced
air trapping in the lungs — in which the airflow limitation of
COPD results in air remaining in the lungs even when the sufferer has
fully exhaled — and improved exercise endurance in patients with
COPD. Both studies were funded by Boehringer Ingelheim and Pfizer Inc,
which jointly market tiotropium. |
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