title: Efficacy of tiotropium in COPD patients from Asia: a subgroup analysis from the UPLIFT trial.
abstract: OBJECTIVE
  Studies in respiratory diseases other than chronic obstructive pulmonary disease suggest potentially differing responses to medications among patients from different regions. We report a subgroup analysis of patients recruited to Asian centres from a previously reported 4-year COPD trial.
  
  
  METHODS
  Subgroup analysis from a randomized, double-blinded, placebo-controlled trial of tiotropium 18 µg daily in COPD. Primary end-point was rate of decline in FEV(1) . Secondary end-points included spirometry at individual time points, health-related quality of life (St George's Respiratory Questionnaire), exacerbations and mortality.
  
  
  RESULTS
  Of 5992 patients, 362 were from Asian centres (100 from Japan). Mean age 66 years, 95% men, 13% current smokers, BMI: 21 kg/m(2) ; post-bronchodilator FEV(1) : 44% predicted; St George's Respiratory Questionnaire total score: 44 units. No treatment effect was observed for rate of decline in FEV(1) although annual decline was less in Asian patients. Morning pre-bronchodilator FEV(1) and forced vital capacity improved in Asian patients (P < 0.05). Tiotropium reduced number of exacerbations (rate ratio (95% confidence interval (CI)): 0.73 (0.57-0.94)). Hazard ratios (95%CI) for exacerbations and hospitalized exacerbations (tiotropium/control) were 0.81 (0.62-1.05) and 0.85 (0.61-1.19), respectively. St George's Respiratory Questionnaire total score improved by 1.5-6.1 units (P < 0.05 for months 18, 24, 30 and 36) with tiotropium. Fatal events occurred in 34 tiotropium (18.5%) and 42 control (23.6%) patients.
  
  
  CONCLUSIONS
  In COPD patients from Asia, tiotropium improves lung function, improves health-related quality of life and reduces exacerbations over 4 years of treatment.
authors.affiliation: Juntendo University, Tokyo, Japan. yfukuchi@tea.ocn.ne.jp
authors.forename: Yoshinosuke
authors.initials: Y
authors.lastname: Fukuchi
authors.forename: Lenora
authors.initials: L
authors.lastname: Fernandez
authors.forename: Han-Pin
authors.initials: HP
authors.lastname: Kuo
authors.forename: Aziah
authors.initials: A
authors.lastname: Mahayiddin
authors.forename: Bartolome
authors.initials: B
authors.lastname: Celli
authors.forename: Marc
authors.initials: M
authors.lastname: Decramer
authors.forename: Steven
authors.initials: S
authors.lastname: Kesten
authors.forename: Dacheng
authors.initials: D
authors.lastname: Liu
authors.forename: Donald
authors.initials: D
authors.lastname: Tashkin
mesh_terms: D000368:Aged; D001208:Asia / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D011788:Quality of Life; D012602:Scopolamine Derivatives / Q000627:therapeutic use*; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide