Short-term effects of inhalative tiotropium/formoterol/budenoside versus tiotropium/formoterol in patients with newly diagnosed chronic obstructive pulmonary disease requiring surgery for lung cancer: a prospective randomized trial.
OBJECTIVE
A new diagnosis of chronic obstructive pulmonary disease (COPD) is often made during the evaluation of patients requiring a surgical intervention for lung cancer. Based on initial impaired lung function, these untreated patients are often considered not fit for lung surgery. There is limited information on the short-term effectiveness of preoperative pharmacologic treatment strategies in patients with newly diagnosed COPD before lung surgery.


METHODS
A prospective randomized study was conducted comparing 1-week-treatment periods of tiotropium/formoterol/budenoside (GR1) with tiotropium/formoterol (GR2) in conjunction with smoking cessation and chest physiotherapy. No patients had been previously treated for COPD. The primary end point was body plethysmography (forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), and airway resistance (RAW)) at the end of each treatment period. Secondary end points were improvement of ≥ 10% in FEV1 (% predicted) and improvement of the severity of COPD after the 1-week treatment, as well as the rate of pulmonary complications after surgery.


RESULTS
A total of 46 patients were randomized in GR1 (n=24) and GR2 (n=22). Both groups were comparable with regard to age, height, weight, smoking history, baseline body plethysmography (FVC, FEV1, and RAW), and the severity of COPD according to the Global Initiative for Obstructive Lung Disease (GOLD) staging, respectively. However, the short-term effects of the treatment with regard to FEV1 (2.0 l vs 1.7 l; p=0.031) and increase of FEV1 (0.31 l vs 0.10 l; p=0.02) were better in GR1. More patients in GR1 had an improvement of ≥ 10% in FEV1 (p=0.004) and improvement of the severity of COPD (p=0.012) after the 1-week treatment. Fewer pulmonary complications (11.1% vs 42.9%, p=0.04) were observed in GR1 after surgery.


CONCLUSIONS
Both therapies resulted in an improvement of lung function. There is benefit from adding inhalative budenoside to tiotropium and formoterol in terms of an improvement in FEV1 and the severity of COPD. These beneficial results might lead to less pulmonary complications in the postoperative period.
Department of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany. Dr.Bolukbas@gmx.de
Servet
S
Bölükbas
Michael
M
Eberlein
Jennifer
J
Eckhoff
Joachim
J
Schirren
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000403:Airway Resistance / Q000187:drug effects; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019819:Budesonide / Q000008:administration & dosage / Q000627:therapeutic use*; D000069502:Budesonide, Formoterol Fumarate Drug Combination; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000601:surgery*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004812:Epidemiologic Methods; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D010993:Plethysmography, Whole Body / Q000379:methods; D011013:Pneumonectomy / Q000009:adverse effects; D011300:Preoperative Care / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012602:Scopolamine Derivatives / Q000008:administration & dosage / Q000627:therapeutic use*; D016540:Smoking Cessation; D000069447:Tiotropium Bromide; D016896:Treatment Outcome; D014797:Vital Capacity / Q000187:drug effects
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D000069502:Budesonide, Formoterol Fumarate Drug Combination; D004338:Drug Combinations; D004983:Ethanolamines; D012602:Scopolamine Derivatives; D019819:Budesonide; D000069447:Tiotropium Bromide