title: Determinants of Long-Term Persistence with Tiotropium Bromide for Chronic Obstructive Pulmonary Disease.
abstract: Tiotropium bromide, a long-acting anticholinergic agent, improves pulmonary function and quality of life of patients suffering from chronic obstructive pulmonary disease (COPD). We retrospectively examined the factors that determine the long-term persistence with tiotropium bromide. Among 6,301 patients who underwent pulmonary function tests in our pulmonary clinic between 2006 and 2009, 644 met the following criteria: 1) age > 40 years, 2) ≥ 20 pack-years smoking history, and 3) forced expiratory volume in 1 sec / forced vital capacity ratio < 0.7. The clinical information, including the prescription of tiotropium, was obtained from the patients' records. Tiotropium was administered to 255 patients (40%), of whom 48 (19%) discontinued treatment within 1 year, and 65 (25%) discontinued treatment within the median observation period of 32 months. The drug was discontinued because of ineffectiveness in 35 patients (73%), and because of adverse drug effects in 13 patients (27%). Young age, current smoking, absence of respiratory symptoms alleviation, and less severe disease characterized by a) mild airflow limitation, b) mild to moderate emphysema, or c) no exacerbation of COPD during the 1(st) year of treatment were predictors of drug discontinuation.
authors.affiliation: 1Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine , Tokyo , Japan.
authors.forename: Kyuto
authors.initials: K
authors.lastname: Tanaka
authors.forename: Nobufumi
authors.initials: N
authors.lastname: Kamiishi
authors.forename: Jun
authors.initials: J
authors.lastname: Miyata
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kabata
authors.forename: Katsunori
authors.initials: K
authors.lastname: Masaki
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ogura-Tomomatsu
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Tomomatsu
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Koichi
authors.initials: K
authors.lastname: Fukunaga
authors.forename: Koichi
authors.initials: K
authors.lastname: Sayama
authors.forename: Tomoko
authors.initials: T
authors.lastname: Betsuyaku
authors.forename: Koichiro
authors.initials: K
authors.lastname: Asano
mesh_terms: D000367:Age Factors; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D055118:Medication Adherence; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D000069447:Tiotropium Bromide / Q000627:therapeutic use*; D014797:Vital Capacity
chemical_list: D001993:Bronchodilator Agents; D000069447:Tiotropium Bromide
keywords: anticholinergic therapy; long-term therapy; tachyphylaxis; treatment effectiveness; treatment tolerability