title: [Short-term effect of tiotropium in COPD patients being treated with a beta2 agonist].
abstract: OBJECTIVE
  To evaluate the short-term impact of tiotropium in patients with severe or very severe COPD who complain of dyspnea despite being currently treated with other bronchodilators.
  
  
  METHODS
  A prospective study including patients with severe or very severe COPD and complaining of dyspnea at rest or on minimal exertion. Every 15 days, the bronchodilator treatment regimen was altered, from salmeterol to tiotropium to salmeterol+tiotropium. At the end of each regimen, pulmonary function tests and the six-minute walk test (6MWT) were performed. The degree of dyspnea and the ability to perform activities of daily living were also assessed. To evaluate patient ability to perform activities of daily living, we employed the London Chest Activity of Daily Living (LCADL), validated for use in Brazil.
  
  
  RESULTS
  We evaluated 52 patients, 30 of whom completed the study. The use of tiotropium in isolation resulted in significant improvement in dyspnea at baseline (mean Medical Research Council scale score reduced from 3.0 to 2.5) and at the end of 6MWT (mean Borg scale score reduced from 6.1 to 4.5), and the differences were significant (p < 0.05 for both). The use of the salmeterol+tiotropium combination resulted in a significant (81 mL) increase in FEV1 and a 5.7 point improvement in the LCADL score.
  
  
  CONCLUSIONS
  The introduction of tiotropium into the treatment of patients with severe or very severe COPD and using long-acting beta2 agonists improves pulmonary function and provides symptomatic relief, as perceived by patients in the short term. These results, obtained under real life treatment conditions, support the use of the salmeterol+tiotropium combination in specific treatment protocols for these patients.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. pnefred@incor.usp.br
authors.forename: Frederico Leon Arrabal
authors.initials: FL
authors.lastname: Fernandes
authors.forename: Vanessa Aparecida Leão
authors.initials: VA
authors.lastname: Pavezi
authors.forename: Sérvulo Azevedo
authors.initials: SA
authors.lastname: Dias
authors.forename: Regina Maria Carvalho
authors.initials: RM
authors.lastname: Pinto
authors.forename: Rafael
authors.initials: R
authors.lastname: Stelmach
authors.forename: Alberto
authors.initials: A
authors.lastname: Cukier
mesh_terms: D000203:Activities of Daily Living; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000420:Albuterol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000145:classification / Q000494:pharmacology; D004338:Drug Combinations; D004417:Dyspnea / Q000188:drug therapy*; D004812:Epidemiologic Methods; D005080:Exercise Test / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D000068299:Salmeterol Xinafoate; D012602:Scopolamine Derivatives / Q000009:adverse effects* / Q000494:pharmacology; D000069447:Tiotropium Bromide; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
chemical_list: D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D004338:Drug Combinations; D012602:Scopolamine Derivatives; D000068299:Salmeterol Xinafoate; D000420:Albuterol; D000069447:Tiotropium Bromide