Whilst recent large-scale studies have provided much evidence on the natural history and therapeutic response in patients with
chronic obstructive pulmonary disease (
COPD), relatively little is known about the effect in younger patients. We report a pre-specified post-hoc analysis of 356 patients with
COPD ≤ 50 years old from the four year randomised, double blind placebo controlled Understanding Potential Long Term Impact on Function with
Tiotropium (UPLIFT) trial. Inclusion criteria included a post-
bronchodilator forced expiratory volume in 1 s (FEV(1)) of ≤70%, FEV(1)/FVC < 0.70, age ≥40 years, and smoking history of ≥10 pack years. Younger patients had a mean FEV(1) of 1.24 L (39% predicted) and an impaired health-related quality of life (St. George's Respiratory Questionnaire (SGRQ)) compared to the entire UPLIFT population. There were 40.2% women and 51.1% current smokers in the younger age group.
Tiotropium was associated with a sustained improvement in spirometry and SGRQ. Mean decline in post-
bronchodilator FEV(1) was 58 ml/year (placebo) vs. 38 ml/year (
tiotropium) (p = 0.01). Corresponding values for pre-
bronchodilator FEV(1) were 41 ml/year (placebo) compared with 34 ml/year (
tiotropium) (p = 0.34). The hazard ratio (95%CI) for an exacerbation in the younger age group was 0.87(0.68, 1.13)). The rate of exacerbations was reduced by
tiotropium (rate ratio (95%CI) = 0.73(0.56, 0.95)).
Tiotropium resulted in sustained bronchodilation, improved quality of life, and a decreased exacerbation rate in younger patients.
Tiotropium also resulted in a significant reduction in the decline in post-
bronchodilator FEV(1), suggesting possible disease modification by
tiotropium in younger patients with
COPD.