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Long-Term Response to Tiotropium, an Anticholinergic Bronchodilator for COPD

Both reversible and nonreversible airflow obstruction responded to long-term daily tiotropium.

Tiotropium is a new inhaled anticholinergic bronchodilator that can be given once daily (Journal Watch Jan 2 2001). In this manufacturer-supported randomized trial, researchers examined whether short-term bronchodilation predicted long-term response to this drug.

A total of 846 patients with chronic obstructive pulmonary disease received inhaled tiotropium or placebo once daily. According to spirometry performed after the first dose of tiotropium, patients in the tiotropium group were classified further as either good or poor short-term responders (good response was defined as improvement in FEV₁ by 12% and 200 mL within 3 hours). After 1 year, the mean morning pre-dose FEV₁ had increased significantly compared with baseline levels, by 174 mL among good short-term responders and by 56 mL among poor short-term responders; FEV₁ had decreased by 38 mL in the placebo group. For a variety of clinical measurements (e.g., dyspnea scores, respiratory quality-of-life scores, frequency of hospitalizations for COPD exacerbations), outcomes were best among good short-term tiotropium responders, were intermediate among poor short-term tiotropium responders, and were poorest among placebo recipients.

Comment: Inhaled tiotropium, which has the advantage of once-daily administration, conferred spirometric and clinical benefits in this study. Patients without substantial bronchodilation after their first dose of tiotropium nevertheless showed some spirometric and clinical improvement after 1 year (although their average improvement was less impressive than that of short-term responders). Thus, the authors believe that poor response to a single dose should not rule out a trial of tiotropium for long-term therapy. Tiotropium is available in Europe but not yet in the U.S.

— Allan S. Brett, MD

Published in Journal Watch General Medicine May 27, 2003

Citation(s):

Tashkin D and Kesten S. Long-term treatment benefits with tiotropium in COPD patients with and without short-term bronchodilator responses. Chest 2003 May; 123:1441-9.

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