Early-Stage COPD Patients May Benefit from Long-Term Tiotropium Use

Long-term use of tiotropium improves lung function and slows the decline in lung function among patients with mild to moderate chronic obstructive pulmonary disease (COPD), according to a recent study.

Since patients with mild to moderate COPD typically have few symptoms, they rarely receive medications. Therefore, little is known about the effects of tiotropium on lung function in these patients.
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To investigate this further, the researchers evaluated 841 patients in China with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 or 2 COPD. Patients were randomly assigned to receive either a once-daily inhaled dose of 18 μg tiotropium (n = 419) or matching placebo (n = 422) for 2 years.

The researchers defined the primary outcome as the difference between groups in the change in forced expiratory volume in 1 second (FEV₁) prior to bronchodilator use from baseline to 24 months. Secondary outcomes were defined as the difference between groups in the change in FEV₁ after bronchodilator use from baseline to 24 months and the difference between groups in the annual decline in FEV₁ prior to and after bronchodilator use from 30 days to 24 months.

The analysis included 388 patients in the tiotropium group and 383 in the placebo group. Results indicated that FEV₁ was higher among patients in the tiotropium group throughout the trial vs those in the placebo group, with the mean differences being 127 ml to 169 ml prior to bronchodilator use, and 71 ml to 133 ml after bronchodilator use.

In addition, the mean annual decline in FEV₁ prior to bronchodilator use did not improve significantly. This decline was 38±6 ml per year in patients receiving tiotropium and 53±6 ml per year in patients receiving placebo. However, the annual decline in FEV₁ after bronchodilator use was significantly less in patients receiving tiotropium (29±5 ml per year) vs patients receiving placebo (51±6 ml per year).

“Tiotropium resulted in a higher FEV₁ than placebo at 24 months and ameliorated the annual decline in the FEV₁ after bronchodilator use in patients with COPD of GOLD stage 1 or 2,” the researchers concluded.

—Christina Vogt

Reference:

Zhou Y, Zhong NS, Li X, et al. Tiotropium in early-stage chronic obstructive pulmonary disease. N Engl J Med. 2017;377:923-935. doi:10.1056/NEJMoa1700228.