Document Detail


Long-acting anticholinergic use in chronic obstructive pulmonary disease: efficacy and safety.
MedLine Citation:
PMID:  20019615     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: This article reviews findings from recently published randomized controlled trials and systematic reviews to provide an up-to-date assessment of the efficacy and safety of tiotropium, the only currently available long-acting muscarinic antagonist, when used alone or in conjunction with other respiratory medications in the treatment of chronic obstructive pulmonary disease (COPD). RECENT FINDINGS: Results of recent clinical trials support findings from earlier trials in patients with moderate to very severe COPD demonstrating significant benefits of tiotropium compared to placebo, including sustained increases in lung function, reductions in exacerbations and risk of exacerbation-related hospitalizations, and improvement in health status. These benefits were particularly noted in the 4-year UPLIFT study that included 5993 COPD patients, including a large percentage with moderate severity. Whereas the cardiovascular safety of tiotropium has been questioned, results of the UPLIFT trial and a recent pooled analysis of data from 30 trials of tiotropium demonstrated that tiotropium is associated with reductions in the risk of all-cause mortality, cardiovascular mortality and cardiovascular events. SUMMARY: Recent findings confirm the benefits of tiotropium in COPD management and provide reassurance regarding its safety. Moreover, the recent UPLIFT trial provides supportive evidence for the efficacy of tiotropium in COPD patients already receiving treatment with long-acting inhaled beta-agonists and inhaled corticosteroids, suggesting advantages of 'triple' therapy in advanced disease. Further, well designed, adequately powered studies should explore the potential advantages and disadvantages of various combinations of currently available long-acting respiratory medications in COPD, particularly in different clinical phenotypes of this heterogeneous disease.
Authors:
Donald P Tashkin
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in pulmonary medicine     Volume:  16     ISSN:  1531-6971     ISO Abbreviation:  Curr Opin Pulm Med     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-01-29     Completed Date:  2010-05-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9503765     Medline TA:  Curr Opin Pulm Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  97-105     Citation Subset:  IM    
Affiliation:
Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, California 90095-1690, USA. dtashkin@mednet.ucla.edu
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MeSH Terms
Descriptor/Qualifier:
Cholinergic Antagonists / adverse effects,  therapeutic use*
Drug Therapy, Combination
Drug Toxicity
Humans
Pulmonary Disease, Chronic Obstructive / drug therapy*
Scopolamine Derivatives / adverse effects,  therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Cholinergic Antagonists; 0/Scopolamine Derivatives; 136310-93-5/tiotropium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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