Document Detail

Tiotropium induced bronchodilation and protection from dynamic hyperinflation is independent of extent of emphysema in COPD.
MedLine Citation:
PMID:  19138754     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The magnitude of tiotropium (1) induced bronchodilation and (2) protection against dynamic hyperinflation in COPD phenotypes has not been studied. METHODS: We studied moderate to severe COPD patients with varying extent of emphysema as evaluated by high-resolution thin-section lung CT. Spirometry including inspiratory capacity (IC) was measured before and immediately after metronome paced hyperventilation (MPH) at 2 times resting respiratory rate for 20s to induce dynamic hyperinflation. Spirometry was obtained at baseline and pre- and 1.5h post-18 microg tiotropium via HandiHaler after 30 day tiotropium treatment period in a single blind, open label intervention. RESULTS: In 29 COPD patients (15M), age 70+/-9 years (mean+/-SD) with smoking history of 53+/-37 pack years, baseline forced expiratory volume in 1s (FEV(1)) post-180 microg albuterol MDI was 1.6+/-0.4 L (61+/-8% predicted) and FEV(1)/FVC 59+/-6%. Lung CT emphysema score (LCTES) was 23+/-20 (mean+/-SD) on a scale of 0-100 (none to most severe emphysema). After 30-day tiotropium, FEV(1) increased 101+/-124 mL (mean+/-SD) (p<0.001) and Spearman correlation (r)=-0.04, p=0.8 with LCTES; IC increased 163+/-232 mL (p<0.001), and r=-0.2, p=0.3 with LCTES. Results following MPH induced DH before and after 30-day tiotropium were significant (p<0.001) and similar: IC decreased 340+/-280 mL before and 337+/-270 mL after tiotropium, and r=-0.3, p=0.9 with LCTES. CONCLUSION: Tiotropium significantly increased FEV(1) (L) and inspiratory capacity in moderate-severe COPD, independent of extent of lung CT emphysema score. Despite bronchodilation and lower resting lung volume, tiotropium did not abbreviate induced dynamic hyperinflation, which was also independent of underlying emphysema.
Arthur F Gelb; Colleen Flynn Taylor; Cara Cassino; Chris M Shinar; Mark J Schein; Noe Zamel
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-01-03
Journal Detail:
Title:  Pulmonary pharmacology & therapeutics     Volume:  22     ISSN:  1522-9629     ISO Abbreviation:  Pulm Pharmacol Ther     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-01     Completed Date:  2009-07-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9715279     Medline TA:  Pulm Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  237-42     Citation Subset:  IM    
Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, Lakewood, CA, USA.
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MeSH Terms
Bronchodilator Agents / pharmacology*
Forced Expiratory Volume / physiology
Hyperventilation / physiopathology*
Middle Aged
Pulmonary Disease, Chronic Obstructive / drug therapy*,  radiography
Pulmonary Emphysema / complications,  physiopathology*
Respiratory Function Tests
Scopolamine Derivatives / pharmacology*
Smoking / physiopathology
Tomography, X-Ray Computed
Vital Capacity
Reg. No./Substance:
0/Bronchodilator Agents; 0/Scopolamine Derivatives; 136310-93-5/tiotropium

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