Effects of short-acting bronchodilators added to maintenance tiotropium therapy.

Abstract

BACKGROUND:

Combining bronchodilators has been shown to be beneficial in patients with COPD. The additive effects of short-acting bronchodilators added to maintenance tiotropium therapy, however, are unknown.

METHODS:

Following 3 weeks of tiotropium pretreatment, 60 patients with COPD (FEV1 40% of predicted) participated in a randomized, placebo-controlled study to assess add-on bronchodilator effects of ipratropium bromide (40 microg) or fenoterol (200 microg). Short-acting bronchodilators were added as a single dose 2 h and 8 h after tiotropium dosing. Serial lung function tests were performed over 9 h.

RESULTS:

The peak FEV1 add-on response within 6 h with fenoterol was significantly greater than with placebo (137 mL) or ipratropium (84 mL); the response with ipratropium was slightly but significantly larger than with placebo (52 mL). One hour after the second dose of the test drugs, a similar order of treatment responses was found. The peak FVC add-on response was significant for fenoterol (249 mL) but not for ipratropium (42 mL).

CONCLUSIONS:

In conclusion, both short-acting bronchodilator classes were effective when added to maintenance treatment with tiotropium. The addition of the beta2-adrenergic fenoterol provided greater additional bronchodilatation than the short-acting anticholinergic ipratropium. This is consistent with the expected effects of combining bronchodilators with different pharmacologic mechanisms. This randomized controlled trial was registered at www.clinicaltrials.gov (NCT00274066).

• Authors: Huib A M Kerstjens, Theo A Bantje, Peter B Luursema, Henk E J Sinninghe Damste, Jan W de Jong, Angela Lee, Stella P C Wijker, Piet J G Cornelissen
• Journal: Chest (Chest) Vol. 132 Issue 5 Pg. 1493-9 (Nov 2007) ISSN: 0012-3692 [Print] United States
• PMID: 17890476 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Bronchodilator Agents
• Scopolamine Derivatives
• Fenoterol
• Ipratropium
• Tiotropium Bromide

Topics

• Bronchodilator Agents (administration & dosage)
• Drug Therapy, Combination
• Female
• Fenoterol (administration & dosage)
• Forced Expiratory Volume
• Humans
• Ipratropium (administration & dosage)
• Male
• Middle Aged
• Plethysmography
• Pulmonary Disease, Chronic Obstructive (drug therapy)
• Respiratory Function Tests
• Scopolamine Derivatives (administration & dosage)
• Tiotropium Bromide
• Treatment Outcome