title: Effect of tiotropium on sputum and serum inflammatory markers and exacerbations in COPD.
abstract: Chronic obstructive pulmonary disease (COPD) patients experiencing frequent exacerbations demonstrate increased stable-state airway inflammation. Tiotropium has been shown to reduce exacerbation frequency, but its effect on airway inflammation is unknown. The aim of the present study was to investigate the effect of tiotropium on sputum inflammatory markers and exacerbation frequency. Patients (n = 142) were randomised to receive tiotropium or placebo in addition to their usual medication for 1 yr. Sputum and serum cytokines were assayed by ELISA and exacerbation frequency calculated using a symptom-based diary. There was no difference in the area under the curve for sputum interleukin (IL)-6 or myeloperoxidase between the groups, but sputum IL-8 level was increased in the tiotropium arm. There was no difference between start and end of study in serum IL-6 or C-reactive protein level. Tiotropium was associated with a 52% reduction in exacerbation frequency (1.17 versus 2.46 exacerbations.yr(-1)). Of patients on tiotropium, 43% experienced at least one exacerbation, compared with 64% on placebo. The total number of exacerbation days was reduced compared with placebo (17.3 versus 34.5 days). Tiotropium reduces exacerbation frequency in chronic obstructive pulmonary disease, but this effect does not appear to be due to a reduction in airway or systemic inflammation.
authors.affiliation: Academic Unit of Respiratory Medicine, Royal Free and University College Medical School, Rowland Hill Street, London, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Powrie
authors.forename: T M A
authors.initials: TM
authors.lastname: Wilkinson
authors.forename: G C
authors.initials: GC
authors.lastname: Donaldson
authors.forename: P
authors.initials: P
authors.lastname: Jones
authors.forename: K
authors.initials: K
authors.lastname: Scrine
authors.forename: K
authors.initials: K
authors.lastname: Viel
authors.forename: S
authors.initials: S
authors.lastname: Kesten
authors.forename: J A
authors.initials: JA
authors.lastname: Wedzicha
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D016207:Cytokines / Q000097:blood*; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009195:Peroxidase / Q000097:blood; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000276:immunology; D012602:Scopolamine Derivatives / Q000627:therapeutic use*; D013183:Sputum / Q000276:immunology*; D000069447:Tiotropium Bromide; D016896:Treatment Outcome; D014797:Vital Capacity / Q000187:drug effects
chemical_list: D001993:Bronchodilator Agents; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D012602:Scopolamine Derivatives; D002097:C-Reactive Protein; D009195:Peroxidase; D000069447:Tiotropium Bromide