Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD

被引:260
作者
Casaburi, R
Kukafka, D
Cooper, CB
Witek, TJ
Kesten, S
机构
[1] Univ Calif Los Angeles, Med Ctr, Div Resp & Crit Care Physiol & Med, Los Angeles Biomed Res Inst Harbor, Torrance, CA 90502 USA
[2] N Colorado Pulmonary Consultants PC, Ft Collins, CO USA
[3] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA USA
[4] Boehringer Ingelheim Pharmaceut Inc, Ridgefield, CT 06877 USA
关键词
COPD; exercise; pulmonary rehabilitation; tiotropium;
D O I
10.1378/chest.127.3.809
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objectives: Pulmonary rehabilitation (PR) improves exercise tolerance in COPD patients. Tiotropium is a once-daily, inhaled anticholinergic bronchodilator that provides sustained 24-h improvements in airflow and lung hyperinflation reduction. We hypothesized that ventilatory mechanics improvements from tiotropium would permit enhanced ability to train muscles of ambulation and therefore augment exercise tolerance benefits of PR. Design: In a randomized, double-blind, placebo-controlled trial (tiotropium, n = 47; placebo, n = 44), tiotropium (18 mu g qd) was administered to COPD patients participating in 8 weeks of PR (treadmill training three times a week; >= 30 min per session) at 17 sites. Study drug was administered 5 weeks prior to, 8 weeks during, and 12 weeks following PR. The primary end point was treadmill walking (0% incline) endurance time at 80% of maximum speed attained in an initial incremental test. The transition dyspnea index (TDI), St. George's respiratory questionnaire (SGRQ), and rescue albuterol use were secondary end points. Participants: Mean age of the 93 participants was 67 years, 57% were men, and mean FEV1 was 0.88 L (34% predicted). Results: Mean endurance time differences (tiotropium minus placebo) prior to PR, at the end of PR, and 12 weeks after PR were 1.65 min (p = 0.183), 5.35 min (p = 0.025), and 6.60 min (p = 0.018), respectively. Mean TDI focal scores at the end of PR were 1.75 for tiotropium and 0.91 for placebo (p > 0.05). At 12 weeks after PR, TDI focal scores were 1.75 for tiotropium and 0.08 for placebo (p < 0.05). Relative to placebo, tiotropium improved SGRQ total scores by 3.86 at the end of PR and 4.44 at 12 weeks after PR (p > 0.05). Mean albuterol use declined following PR plus tiotropium, compared to PR alone (p <= 0.05 for 17 of 25 weeks). Conclusions: Tiotropium in combination with PR improved endurance of a constant work rate treadmill task and produced clinically meaningful improvements in dyspnea and health status compared to PR alone. Improvements with tiotropium were sustained for 3 months following PR completion.
引用
收藏
页码:809 / 817
页数:9
相关论文
共 25 条
[1]  
American Thoracic Society, 1999, AM J RESP CRIT CARE, V159, P1666
[2]  
[Anonymous], 1995, AM J RESP CRIT CARE, V152, P1107
[4]   Health outcomes following treatment for six months with once daily tiotropium compared with twice daily salmeterol in patients with COPD [J].
Brusasco, V ;
Hodder, R ;
Miravitlles, M ;
Korducki, L ;
Towse, L ;
Kesten, S .
THORAX, 2003, 58 (05) :399-404
[5]   A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease [J].
Casaburi, R ;
Mahler, DA ;
Jones, PW ;
Wanner, A ;
San Pedro, G ;
ZuWallack, RL ;
Menjoge, SS ;
Serby, CW ;
Witek, T .
EUROPEAN RESPIRATORY JOURNAL, 2002, 19 (02) :217-224
[6]   Improvement in resting inspiratory capacity and hyperinflation with tiotropium in COPD patients with increased static lung volumes [J].
Celli, B ;
ZuWallack, R ;
Wang, S ;
Kesten, S .
CHEST, 2003, 124 (05) :1743-1748
[7]  
CELLI BR, 1995, AM J RESP CRIT CARE, V152, pS77
[8]   Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction [J].
Foglio, K ;
Bianchi, L ;
Bruletti, G ;
Battista, L ;
Pagani, M ;
Ambrosino, N .
EUROPEAN RESPIRATORY JOURNAL, 1999, 13 (01) :125-132
[9]   A randomised controlled trial of four weeks versus seven weeks of pulmonary rehabilitation in chronic obstructive pulmonary disease [J].
Green, RH ;
Singh, SJ ;
Williams, J ;
Morgan, MDL .
THORAX, 2001, 56 (02) :143-145
[10]   A SELF-COMPLETE MEASURE OF HEALTH-STATUS FOR CHRONIC AIR-FLOW LIMITATION - THE ST-GEORGES RESPIRATORY QUESTIONNAIRE [J].
JONES, PW ;
QUIRK, FH ;
BAVEYSTOCK, CM ;
LITTLEJOHNS, P .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1992, 145 (06) :1321-1327