Treatment with the tiotropium (Spiriva) can reduce exacerbations of Chronic obstructive pulmonary disease (COPD) and may, as a result, reduce healthcare utilization among patients with moderate to severe disease, new research suggests.
Previous reports have shown that treatment with tiotropium can improve lung function, shortness of breath and quality of life in COPD patients. Moreover, there was evidence that the drug may help reduce disease flare-ups, although this was not a primary focus of the studies.
To investigate this topic further, Dr. Dennis E. Niewoehner, from the VA Medical Center in Minneapolis, and colleagues assessed the rate of COPD exacerbations among 1,829 patients who were randomly assigned to receive once-daily tiotropium or placebo for 6 months. All of the subjects continued their usual medications except for other bronchodilators in the same drug class as tiotropium.
Chronic obstructive pulmonary disease Definition
Chronic obstructive pulmonary disease (COPD) is a group of lung diseases involving limited airflow and varying degrees of air sac enlargement, airway inflammation, and lung tissue destruction. Emphysema and chronic bronchitis are the most common forms of COPD.
The researchers’ findings appear in the Annals of Internal Medicine.
In the tiotropium group, significantly fewer (27.9 percent) of patients experienced at least one COPD flare-up compared with patients in the placebo group (32.3 percent). In addition, there was a trend toward reduction in the rate of COPD-related hospitalization when using tiotropium rather than placebo: 7.0 percent vs. 9.5 percent.
COPD Causes, incidence, and risk factors
The leading cause of COPD is smoking, which can lead to the two most common forms of this disease, emphysema and chronic bronchitis.
Prolonged tobacco use causes lung inflammation and variable degrees of air sac (alveoli) destruction. This leads to inflamed and narrowed airways (chronic bronchitis) or permanently enlarged air sacs of the lung with reduced lung elasticity (emphysema). Between 15% and 20% of long-term smokers will develop COPD.
Other risk factors for COPD are passive smoking (exposure of non-smokers to cigarette smoke from others), male gender, and working in a polluted environment. Rarely, an enzyme deficiency called alpha-1 anti-trypsin deficiency can cause emphysema in non-smokers.
Treatment with tiotropium also seemed to lengthen the time to first COPD exacerbation and reduced healthcare utilization for flare-ups, the investigators note. However, tiotropium therapy did not have a significant effect on all-cause hospitalization rates.
SOURCE: Annals of Internal Medicine, September 6, 2005.
Revision date: July 9, 2011
Last revised: by Janet A. Staessen, MD, PhD