Extended Therapy With Ipratropium Is Associated With Improved Lung Function in Patients With COPD

Rennard, Stephen I.; Serby, Charles W.; Ghafouri, Mo; Johnson, Philip A.; Friedman, Mitchell

doi:10.1378/chest.110.1.62

Cited by 111 publications

(45 citation statements)

References 21 publications

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“…The sparse publications that have addressed this issue are mainly limited to short-term, 3-month studies involving anticholinergic bronchodilators and have yielded somewhat conflicting findings, as described above [1,2]; one of these studies showed a substantially, although not significantly, greater numerical response to tiotropium in trough FEV1 in continuing smokers than ex-smokers [1], while the other showed a more marked trough FEV1 response to ipratropium in ex-smokers than current smokers [2].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, in a pooled analysis, stratified by smoking status, of seven clinical trials in which the short-acting anticholinergic bronchodilator, ipratropium, was compared with a b 2 -agonist over a 90-day treatment period in a total of 1,836 subjects with moderately severe COPD, the improvement in baseline lung function in the ipratropium-treated patients was found to be more marked in ex-smokers than current smokers [2].…”

mentioning

confidence: 82%

“…When comparing the efficacy of the long-acting anticholinergic bronchodilator, tiotropium, in a 3-month study between 80 smokers and 224 ex-smokers with chronic obstructive pulmonary disease (COPD), MOITA et al [1] previously reported twice as large a placeboadjusted improvement in pre-bronchodilator forced expired volume in 1 s (FEV1) in the smokers (138 mL) than the ex-smokers (66 mL), although the difference in the response to tiotropium between the two smoking groups was not statistically significant. In contrast, in a pooled analysis, stratified by smoking status, of seven clinical trials in which the short-acting anticholinergic bronchodilator, ipratropium, was compared with a b 2 -agonist over a 90-day treatment period in a total of 1,836 subjects with moderately severe COPD, the improvement in baseline lung function in the ipratropium-treated patients was found to be more marked in ex-smokers than current smokers [2].…”

mentioning

confidence: 82%

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Long-term efficacy of tiotropium in relation to smoking status in the UPLIFT trial

Tashkin¹,

Celli²,

Kesten³

et al. 2009

European Respiratory Journal

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UPLIFT (Understanding Potential Long-Term Improvements in Function with Tiotropium), a 4-yr trial of tiotropium in chronic obstructive pulmonary disease, allowed for assessment of smoking status on long-term responses to maintenance bronchodilator therapy.5,993 patients were randomised (tiotropium/placebo). Lung function, St George's Respiratory Questionnaire, exacerbations and adverse events were followed. Patients were characterised as continuing smokers (CS), continuing ex-smokers (CE), or intermittent smokers (IS) based on selfreporting smoking behaviour.60%, 14% and 26% of patients were CE, CS and IS, respectively. The rate of forced expiratory volume in 1 s (FEV1) decline for placebo patients was most rapid in CS (-51¡4, -36¡2 and -23¡2 mL?yr -1 in CS, IS, and CE, respectively). Tiotropium did not alter FEV1 decline, but was associated with significant improvements in pre-and post-bronchodilator FEV1 over placebo that persisted throughout the 4-yr trial for each smoking status (pre-bronchodilator: 125, 55 and 97 mL at 48 months in CS, IS and CE, respectively; pf0.0003). Tiotropium reduced exacerbation risk in CS (HR ( Tiotropium provided long-term benefits irrespective of smoking status, although differences among categories were observed. KEYWORDS: Chronic obstructive pulmonary disease, forced expiratory volume in 1 s rate of decline, smoking behaviour, tiotropium T he relationship between smoking behaviour and long-term responses to maintenance bronchodilator therapy has not been thoroughly evaluated. When comparing the efficacy of the long-acting anticholinergic bronchodilator, tiotropium, in a 3-month study between 80 smokers and 224 ex-smokers with chronic obstructive pulmonary disease (COPD), MOITA et al.[1] previously reported twice as large a placeboadjusted improvement in pre-bronchodilator forced expired volume in 1 s (FEV1) in the smokers (138 mL) than the ex-smokers (66 mL), although the difference in the response to tiotropium between the two smoking groups was not statistically significant. In contrast, in a pooled analysis, stratified by smoking status, of seven clinical trials in which the short-acting anticholinergic bronchodilator, ipratropium, was compared with a b 2 -agonist over a 90-day treatment period in a total of 1,836 subjects with moderately severe COPD, the improvement in baseline lung function in the ipratropium-treated patients was found to be more marked in ex-smokers than current smokers [2].The 4-yr multinational placebo-controlled trial of tiotropium versus placebo in 5,993 subjects with COPD (UPLIFT, Understanding Potential LongTerm Improvements in Function with Tiotropium) [3] provided an opportunity to assess more fully the potential relationship between smoking status and both lung function and patient-reported outcomes of maintenance therapy with a long-acting muscarinic antagonist over an extended period of time in a large group of continuing smokers, intermittent smokers and ex-smokers with COPD, taking into account the potentially confounding influence o...

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Section: Discussionmentioning

confidence: 99%

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confidence: 82%

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confidence: 82%

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Long-term efficacy of tiotropium in relation to smoking status in the UPLIFT trial

Tashkin¹,

Celli²,

Kesten³

et al. 2009

European Respiratory Journal

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“…A meta-analysis of seven trials in moderate to severe COPD has suggested that the bronchodilator response to the anticholinergic ipratropium may be greater in exsmokers compared with smokers [18]. Examination of the subgroup of ex-smokers in these trials showed them to have a baseline FEV 1 of about 20% less than smokers.…”

Section: Discussionmentioning

confidence: 99%

“…The rationale for performing this trial was based on a meta-analysis from seven clinical trials with the shorteracting anticholinergic, ipratropium, in patients with moderate to severe COPD, which suggested that the improvement in baseline lung function in ipratropiumtreated patients was greater in ex-smokers than in smokers [18]. The aim of this study, entitled 'Spiriva s Assessment of FEV 1 ' (SAFE), was to evaluate whether the effect of tiotropium on the change in trough FEV 1 is affected by smoking status.…”

Section: Introductionmentioning

confidence: 99%

Tiotropium improves FEV1 in patients with COPD irrespective of smoking status

Moita¹,

Bárbara²,

Cardoso³

et al. 2008

Pulmonary Pharmacology & Therapeutics

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This study evaluated whether the effect of tiotropium on the change in trough forced expiratory volume in 1 s (FEV 1 ), vs. placebo, is affected by smoking status. In a 3-month, double-blind study in 31 centres in Portugal, 311 (289 completed) patients were randomised to tiotropium 18 mg once daily or placebo. Baseline mean (standard deviation (SD)) FEV 1 was 1.11 (0.39) l in the tiotropium group and 1.13 (0.39) l in the placebo group. Patients had an average smoking history of 55 (25.7) pack-years; 80 (26%) were smokers and 224 (74%) were ex-smokers. The primary end-point was change in morning pre-dose (i.e. trough) FEV 1 after 12 weeks. Trough FEV 1 at 12 weeks was significantly improved with tiotropium vs. placebo: the difference in means was 102 ml, P ¼ 0.0011, 95% confidence interval (CI) (41, 164). The difference in means in smokers was 138 ml, P ¼ 0.0105, CI (32, 244); in ex-smokers it was 66 ml, P ¼ 0.0375, CI (3, 129). The difference between smokers and ex-smokers was not statistically significant (P ¼ 0.6982) and may be due to greater variability and differences in disease severity. The significant improvement in lung function in patients treated with tiotropium vs. placebo in both smokers and ex-smokers suggests that tiotropium is an effective and well-tolerated therapy in chronic obstructive pulmonary disease (COPD), regardless of smoking status. r

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A 62-Year-Old Woman With Chronic Obstructive Pulmonary Disease

Celli

2003

JAMA

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Extended Therapy With Ipratropium Is Associated With Improved Lung Function in Patients With COPD

Cited by 111 publications

References 21 publications

Long-term efficacy of tiotropium in relation to smoking status in the UPLIFT trial

Long-term efficacy of tiotropium in relation to smoking status in the UPLIFT trial

Tiotropium improves FEV1 in patients with COPD irrespective of smoking status

A 62-Year-Old Woman With Chronic Obstructive Pulmonary Disease

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