Preoperative use of inhaled tiotropium in lung cancer patients with untreated COPD.
OBJECTIVE
Lung cancer patients with COPD are at high risk during surgery. Tiotropium, a long-acting bronchodilator, is a preferred maintenance therapy for COPD, but its efficacy in the perioperative period has not been clarified.


METHODS
A retrospective review was performed of the medical records of 102 patients with primary lung cancer and COPD, who underwent scheduled surgery. Twenty-one lung cancer patients with untreated mild-to-severe COPD received tiotropium preoperatively. Spirometry was performed prior to and after 2 weeks of treatment with tiotropium, and at 3 months after surgery.


RESULTS
Two-week preoperative treatment with tiotropium significantly improved respiratory symptoms and pulmonary function as reflected by FVC (median 3.43 L pretreatment vs 3.52 L post-treatment), FEV(1) (median 2.06 L vs 2.32 L) and FEV(1)% (73.2% vs 81.0%) (all P < 0.001). Postoperative FEV(1)% was significantly increased from a median of 56.0% (interquartile range 51.6-60.3) to 63.4% (60.8-66.0) (P < 0.001). The increase in FEV(1) was inversely associated with severity of COPD (r = -0.59, P < 0.005). Lung resections were successfully accomplished without complications. The postoperative FEV(1) predicted prior to tiotropium treatment was underestimated (median predicted postoperative FEV(1) 1.65 L vs median measured postoperative FEV(1) 1.96 L, P < 0.001).


CONCLUSIONS
Preoperative treatment with tiotropium may facilitate surgical treatment for lung cancer patients with COPD. This is encouraging for COPD patients who may require curative lung resections.
Kobayashi
Seiichi
S
Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki 986-8522, Japan. skoba-thk@umin.ac.jp
Suzuki
Satoshi
S
Niikawa
Hiromichi
H
Sugawara
Takafumi
T
Yanai
Masaru
M
D000280:Administration, Inhalation; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008175:Lung Neoplasms / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology*; D012189:Retrospective Studies; D012602:Scopolamine Derivatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide