Role of tiotropium in the treatment of COPD
Authors Kathryn L Rice, Ken M Kunisaki, Dennis E Niewoehner
Published 15 July 2007 Volume 2007:2(2) Pages 95—105
Kathryn L Rice1,2, Ken M Kunisaki1, Dennis E Niewoehner1,2
1University of Minnesota, and 2Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA
Abstract: Tiotropium is a potent, long-acting, selective anticholinergic bronchodilator. Treatment with tiotropium produces sustained improvements in lung function, particularly FEV1 (peak, trough, average, and area under the curve) compared with either placebo or ipratropium in patients with moderate to severe COPD. Preliminary evidence suggests that treatment with tiotropium may slow the rate of decline in FEV1, but this finding awaits confirmation. Tiotropium reduces lung hyperinflation, with associated improvements in exercise capacity. Tiotropium, compared with either placebo or ipratropium, improves a variety of patient-centered outcomes, including subjective dyspnea ratings and HRQL scores. Tiotropium reduces the frequency of COPD exacerbations and of hospitalizations due to exacerbations, but has not been shown to reduce all-cause mortality. Compared with the long-acting bronchodilators, tiotropium provides incrementally better bronchodilation, but it is not clearly superior in terms of patient-centered outcomes. Tiotropium has a good safety profile; however patients with severe cardiac disease, bladder outlet obstruction, or narrow angle glaucoma were excluded from all studies. Medico economic analyses suggest that treatment with tiotropium may also be cost-effective, primarily by reducing costs associated with hospitalizations.
Keywords: tiotropium, anticholinergic bronchodilator, chronic obstructive pulmonary disease