title: Additive benefits of tiotropium in COPD patients treated with long-acting beta agonists and corticosteroids.
abstract: OBJECTIVE
  The addition of an alternative class of long-acting bronchodilator is recommended for COPD patients who do not respond satisfactorily to monotherapy. The aim of this study was to investigate the additive benefit of tiotropium in severe COPD and to establish whether the improvement in lung function in these patients can be predicted from their acute bronchodilator response to ipratropium or salbutamol.
  
  
  METHODS
  Forty-six patients with severe COPD treated with inhaled long-acting beta(2) agonists and corticosteroids (LABA/CS) were enrolled. Their prebronchodilator FEV(1) was less than 50% of the predicted value. Tiotropium (18 microg, once daily) was added via a dry-powder inhaler device. After a month of treatment, tiotropium was stopped but their previous medication was continued. Patients were reassessed a month later. Acute bronchodilator response to ipratropium and salbutamol was assessed prior to tiotropium treatment. Pulmonary function and health status were evaluated.
  
  
  RESULTS
  Adding tiotropium significantly improved FVC, FEV(1) and inspiratory capacity (IC). The increase in FVC was significantly associated with an increase in IC (r = 0.36, P = 0.019) and a decrease in residual volume (r =-0.56, P < 0.001). Total scores of St. George Respiratory Questionnaire scores were significantly improved after adding tiotropium treatment (P < 0.001). After tiotropium withdrawal, FVC, FEV(1) and IC decreased markedly. Bronchodilator response to ipratropium did not predict the tiotropium-mediated improvement in FEV(1) or FVC.
  
  
  CONCLUSIONS
  Adding tiotropium to inhaled LABA/CS can yield clinical benefits in lung function and improved quality of life in COPD patients, as both drugs act through separate yet complementary pathways to maintain airway calibre.
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road Section 2, Taipei 11217, Taiwan. dwperng@vghtpe.gov.tw
authors.forename: Diahn-Warng
authors.initials: DW
authors.lastname: Perng
authors.forename: Cheng-Che
authors.initials: CC
authors.lastname: Wu
authors.forename: Kang-Cheng
authors.initials: KC
authors.lastname: Su
authors.forename: Yu-Chin
authors.initials: YC
authors.lastname: Lee
authors.forename: Reury-Perng
authors.initials: RP
authors.lastname: Perng
authors.forename: Chi-Wei
authors.initials: CW
authors.lastname: Tao
mesh_terms: D000368:Aged; D000420:Albuterol / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006304:Health Status; D006801:Humans; D007320:Inspiratory Capacity / Q000187:drug effects; D009241:Ipratropium / Q000627:therapeutic use; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012602:Scopolamine Derivatives / Q000627:therapeutic use*; D000069447:Tiotropium Bromide; D014797:Vital Capacity / Q000187:drug effects
chemical_list: D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D009241:Ipratropium; D000420:Albuterol; D000069447:Tiotropium Bromide