Tiotropium induced bronchodilation and protection from dynamic hyperinflation is independent of extent of emphysema in COPD - 05/08/11
, Colleen Flynn Taylor a, 1, Cara Cassino f, Chris M. Shinar d, Mark J. Schein c, Noe Zamel e
Corresponding author. 3650 E. South Street, Suite 308 Lakewood, CA 90712, USA. Tel.: +1 562 633 2204; fax: +1 562 633 2579.Abstract |
Background |
The magnitude of tiotropium (1) induced bronchodilation and (2) protection against dynamic hyperinflation in COPD phenotypes has not been studied.
Methods |
We studied moderate to severe COPD patients with varying extent of emphysema as evaluated by high-resolution thin-section lung CT. Spirometry including inspiratory capacity (IC) was measured before and immediately after metronome paced hyperventilation (MPH) at 2 times resting respiratory rate for 20s to induce dynamic hyperinflation. Spirometry was obtained at baseline and pre- and 1.5h post-18μg tiotropium via HandiHaler after 30 day tiotropium treatment period in a single blind, open label intervention.
Results |
In 29 COPD patients (15M), age 70±9years (mean±SD) with smoking history of 53±37 pack years, baseline forced expiratory volume in 1s (FEV1) post-180μg albuterol MDI was 1.6±0.4L (61±8% predicted) and FEV1/FVC 59±6%. Lung CT emphysema score (LCTES) was 23±20 (mean±SD) on a scale of 0–100 (none to most severe emphysema). After 30-day tiotropium, FEV1 increased 101±124mL (mean±SD) (p<0.001) and Spearman correlation (r)=−0.04, p=0.8 with LCTES; IC increased 163±232mL (p<0.001), and r=−0.2, p=0.3 with LCTES. Results following MPH induced DH before and after 30-day tiotropium were significant (p<0.001) and similar: IC decreased 340±280mL before and 337±270mL after tiotropium, and r=−0.3, p=0.9 with LCTES.
Conclusion |
Tiotropium significantly increased FEV1 (L) and inspiratory capacity in moderate-severe COPD, independent of extent of lung CT emphysema score. Despite bronchodilation and lower resting lung volume, tiotropium did not abbreviate induced dynamic hyperinflation, which was also independent of underlying emphysema.
Le texte complet de cet article est disponible en PDF.Keywords : Tiotropium, Bronchodilators, COPD, Lung function testing, Dynamic hyperinflation, Lung CT, Emphysema
Abbreviations : IC, MPH, DH, LCTES
Plan
 | This research was supported by an Investigator Initiated Grant to AFG and NZ funded by Boehringer-Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut and Pfizer Pharmaceuticals Inc., New York. The authors have no other potential financial conflicts of interest to declare. |
Vol 22 - N° 3
P. 237-242 - juin 2009 Retour au numéro
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