title: Combining triple therapy and pulmonary rehabilitation in patients with advanced COPD: a pilot study.
abstract: BACKGROUND
  The synergistic interactions between pharmacotherapy and pulmonary rehabilitation has been provided, but it remains to be established whether this may also apply to more severe patients.
  
  
  OBJECTIVE
  We have examined whether tiotropium enhances the effects of exercise training in patients with advanced COPD (FEV(1)</=60% predicted, hypoxemia at rest corrected with oxygen supplementation, and limitations of physical activity).
  
  
  METHODS
  We enrolled 22 patients that were randomised to tiotropium 18mug or placebo inhalation capsules taken once daily. Both groups (11 patients in each group) underwent an in patient pulmonary rehabilitation program and were under regular treatment with salmeterol/fluticasone twice daily. Each rehabilitation session was held 5 days per week (3h/day) for a total of 4 weeks.
  
  
  RESULTS
  Compared to placebo, tiotropium had larger impact on pulmonary function (FEV(1)+0.164L, FVC +0.112L, RV -0.544L after tiotropium, FEV(1)+0.084L, FVC -0.039L, RV -0.036L after placebo). The addition of tiotropium allowed a longer distance walked in 6min (82.3m vs. 67.7m after placebo) and reduced dyspnoea (Borg score) (-0.4 vs. +0.18 after placebo) when compared with baseline (pre pulmonary rehabilitation program). The changes in SGRQ from baseline to the end of treatment were: total score -28.3U, activity -27.8U, impact -14.5U, and symptoms -33.4U in the placebo group; and total score -19.1U, activity -18.9U, impact -16.4U, and symptoms -33.8U in the tiotropium group.
  
  
  CONCLUSIONS
  Our study clearly indicates that there is an advantage in combining pulmonary rehabilitation with an aggressive drug therapy in more severe patients.
authors.affiliation: Division of Pulmonary Rehabilitation, San Raffaele Hospital, Velletri (Rome), Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Pasqua
authors.forename: Gianluca
authors.initials: G
authors.lastname: Biscione
authors.forename: Girolmina
authors.initials: G
authors.lastname: Crigna
authors.forename: Laura
authors.initials: L
authors.lastname: Auciello
authors.forename: Mario
authors.initials: M
authors.lastname: Cazzola
mesh_terms: D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000730:Androstadienes / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000379:methods; D004334:Drug Administration Schedule; D004357:Drug Synergism; D004417:Dyspnea / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D000068299:Salmeterol Xinafoate; D012602:Scopolamine Derivatives / Q000008:administration & dosage*; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D000730:Androstadienes; D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol; D000069447:Tiotropium Bromide