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. 2007;2(2):157-67.

Outcomes in COPD patients receiving tiotropium or salmeterol plus treatment with inhaled corticosteroids

Richard Hodder  1 , Steven Kesten, Shailendra Menjoge, Klaus Viel
Affiliations

Outcomes in COPD patients receiving tiotropium or salmeterol plus treatment with inhaled corticosteroids

Richard Hodder et al. Int J Chron Obstruct Pulmon Dis. 2007.

Abstract

Patients with COPD are frequently prescribed inhaled corticosteroids (ICS); however, it is unclear whether the treatment with ICS might modify responses to inhaled bronchodilators. Two 6-month, randomized, placebo-controlled, double-blind, double-dummy, parallel-group studies of tiotropium 18 microg once daily, compared with salmeterol, 50 microg bid, had been conducted in patients with moderate-to-severe COPD. Efficacy was assessed by spirometry, transition dyspnea index (TDI), St. George's Respiratory Questionnaire (SGRQ), and exacerbations. Data from both studies were combined to form subgroups with regard to concurrent use of ICS. 796 patients receiving ICS were separately analyzed from 390 patients not receiving ICS. Mean age was 64 years, and pre-bronchodilator FEV1 was 1.06 L (ICS group) and 1.13 L (non-ICS group). Both bronchodilators increased morning mean +/- SE pre-dose FEV1 compared with placebo (ICS groups: tiotropium 110 +/- 20 mL, salmeterol 80 +/- 20 mL; non-ICS groups: tiotropium 150 +/- 30 mL, salmeterol 110 +/- 30 mL; p > 0.05 for tiotropium vs salmeterol). Improvements in TDI and SGRQ and frequency of exacerbations also tended to be more profound for tiotropium. Treatment with tiotropium in patients with moderate-to-severe COPD was superior to salmeterol in lung function, irrespective of concurrent use of ICS.

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Figures

Figure 1a
Figure 1a
Mean trough FEV1 response of active treatment groups above placebo (patients concurrently using ICS).
Figure 1b
Figure 1b
Mean peak FEV1 response of active treatment groups above placebo (patients concurrently using ICS).
Figure 2a
Figure 2a
Mean trough FEV1 response of active treatment groups above placebo (patients without ICS treatment).
Figure 2b
Figure 2b
Mean peak FEV1 response of active treatment groups above placebo (patients without ICS treatment).
Figure 3
Figure 3
Improvement in health-related quality of life in active treatment groups compared to baseline SGRQ Total score (patients concurrently using ICS).
See this image and copyright information in PMC

Comment in

  • Which bronchodilator in COPD?
    Russell R, Singh D. Russell R, et al. Int J Chron Obstruct Pulmon Dis. 2007;2(2):93-4. Int J Chron Obstruct Pulmon Dis. 2007. PMID: 18046837 Free PMC article. No abstract available.

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