Improvement of pulmonary function and dyspnea by tiotropium in COPD patients using a transdermal β2-agonist

Background: A combination of bronchodilators may be effective in the treatment of chronic obstructive pulmonary disease (COPD). We examined the effect of adding a long-acting anti-cholinergic agent (tiotropium) to a transdermal-type beta(2)-agonist (tulobuterol) on dyspnea as well as pulmonary function. Methods: In a multicentre, randomized, parallel design study, 60 COPD patients treated with the transdermal beta(2)-agonist tulobuterol were divided into a tiotropium added group (Tulo + Tio group, n = 40) or transdermal beta(2)-agonist tulobuterol alone group (Tulo group, n = 20), and then treated for 4 weeks after a 2 week run-in period. Pulmonary function and a dyspnea (Medical Research Council (MRC)) scale were assessed before and after the treatment. Daily peak expiratory flow (PEF) monitoring was also performed. Results: After 4 weeks, the Tulo + Tio group showed a significant increase in pulmonary function compared with the Tulo group; Delta FVC (0.31 +/- 0.06 L vs. 0.06 +/- 0.05 L, p < 0.0 1), Delta FEV1 (0.15 +/- 0.03 L vs. -0.02 +/- 0.02 L, p < 0.0001), and Delta PEF (41.0 +/- 5.1 L/min vs. 0.5 +/- 3.5 L/min, p < 0.0001). The MRC dyspnea scale was also significantly improved in Tulo + Tio, but not in Tulo group. Conclusion: These results suggest that tiotropium caused a significant improvement in both pulmonary function and dyspnea in COPD patients already treated with the transdermal beta(2)-agonist tulobuterol. (C) 2006 Elsevier Ltd. All rights reserved.