Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep 27:12:25.
doi: 10.1186/s40248-017-0105-4. eCollection 2017.

Effects of combination therapy indacaterol/glycopyrronium versus tiotropium on moderate to severe COPD: evaluation of impulse oscillometry and exacerbation rate

Antonio Molino  1 , Francesca Simioli  1 , Anna Agnese Stanziola  1 , Mauro Mormile  1 , Maria Martino  1 , Maria D'Amato  1
Affiliations

Effects of combination therapy indacaterol/glycopyrronium versus tiotropium on moderate to severe COPD: evaluation of impulse oscillometry and exacerbation rate

Antonio Molino et al. Multidiscip Respir Med. .

Abstract

Background: Small airways are considered the major site of airflow limitation in COPD. Impulse oscillometry (IOS) is a forced oscillation technique, which provides passive measurement of lung mechanics. It can differentiate small airway from large airway obstruction and is more sensitive than spirometry for peripheral airway disease. In this study the efficacy of the combination of Indacaterol/Glycopirronium (IND/GLY) versus Tiotropium on airway resistance (R5, R20, R5-20), lung reactance (X) and resonant frequency in moderate to severe COPD patients has been evaluated. We also evaluated inspiratory capacity (IC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), exacerbation rate and quality of life.

Methods: Forty patients were monitored with forced oscillation technique and spirometry. Patients were randomized in 2 groups: 20 received fixed dose once daily Indacaterol/Glycopyrronium (Group A) and 20 received single Tiotropium (Group B). The oscillometry parameters were the measure of resistance in the airways at 5 Hz (R5), at 20 Hz (R20) and the lung reactance (X).

Results: There was a statistically significant difference between pre-dosing at V1 and at follow up visits in R5, R20 and X values in patients receiving dual bronchodilation but not in control group. Pre-dosing IC value at follow up visits in patients receiving dual bronchodilation had a statistical significant variation.

Conclusions: The "new" bronchodilator combination LABA/LAMA significantly reduces bronchial obstruction in small airways too. The oscillometry demonstrated greater sensitivity compared with spirometry for monitoring outcome measures of airway obstruction and the effect of long-term therapy.

Keywords: COPD; Impulse oscillometry lung function; Pulmonary function test; Small airway obstruction.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by Ethics Committee (SUN-AO Dei Colli, Naples, Italy) and all subjects gave their written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Resistance and reactance before and after dual bronchodilation
Fig. 2
Fig. 2
Resistance and reactance before and after tiotropium
Fig. 3
Fig. 3
Pre-dosing Fev1(liters and DS) in two groups at T0 and after 52 weeks
Fig. 4
Fig. 4
Pre-dosing FVC (liters and DS) in two groups at T0 and after 52 weeks
Fig. 5
Fig. 5
Pre-dosing IC in two groups at T0 and after 52 weeks
Fig. 6
Fig. 6
SGRQ mean difference and DS in two groups at T0 and after 52 weeks
See this image and copyright information in PMC

References

    1. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J7 et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195:557-82. - PubMed
    1. Gagnon P, Guenette JA, Langer D, Laviolette L4 Mainguy V, Maltais F, et al. Pathogenesis of hyperinflation in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2014;9:187–201. - PMC - PubMed
    1. Tantucci C, Donati P, Nicosia F, Bertella E, Redolfi S, De Vecchi M, et al. Inspiratory capacity predicts mortality in patients with chronic obstructive pulmonary disease. Respir Med. 2008;102:613–619. doi: 10.1016/j.rmed.2007.11.004. - DOI - PubMed
    1. Hogg JC, Chu F, Utokaparch S, Woods R, Elliott WM, Buzatu L, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:2645–2653. doi: 10.1056/NEJMoa032158. - DOI - PubMed
    1. Eriksson GJL, Peterson S, Ankerst J, Bjermer L, Tufvesson E. A new approach to assess COPD by identifying lung function break-points. Int J Chron Obstruct Pulmon Dis. 2015;10:2193–2202. doi: 10.2147/COPD.S86059. - DOI - PMC - PubMed

LinkOut - more resources