A 4-Year Trial of Tiotropium in Chronic Obstructive Pulmonary Disease

Tashkin, Donald P.; Celli, Bartolomé R.; Senn, Stephen; Burkhart, D; Kesten, Steven; Menjoge, Shailendra; Decramer, Marc

doi:10.1056/nejmoa0805800

Cited by 1,988 publications

(1,959 citation statements)

References 23 publications

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“…The impact of different treatments and specifically long-acting bronchodilators on FEV 1 decline has not been consistently demonstrated in previous high-powered clinical trials. [46] Although the relationship of tobacco with lung function decline has been well established,[47] we did not find this association. We are now starting to understand the genetic determinants that may drive this different response after quitting tobacco.…”

Section: Discussioncontrasting

confidence: 56%

Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort

Lόpez-Campos

Fernández-Villar

Represas-Represas

et al. 2017

European Clinical Respiratory Journal

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Background: COPD is a chronic disease traditionally associated with increased symptoms as lung function deteriorates. Follow-up times in previous cohort studies were limited to a few years. Interestingly, newer longer observational studies show a more comprehensive picture on disease progression over time. Therefore, the question on the relevancy of the follow-up time in cohort studies remains open. Methods: The ON-SINT study is an observational, retrospective, nationwide, real-life cohort study, in which patients diagnosed with COPD were recruited between December 2011 and April 2013 by primary care (PC) and secondary care (SC) physicians. Patients were evaluated at the inclusion visit and at the initial visit when the diagnosis of COPD was first established. Distribution of lung function decline over the years was studied comparing those cases with longer follow-up times, with the median of the distribution as the cutoff point. Results: The sample included 1214 patients of which 857 (70.6%) were recruited by PC and 357 (29.4%) by SC physicians. Median follow-up time was 6.26 years. Mean annual change in the complete cohort were –4.5 (222) ml year–1 for FVC and 5.5 (134) ml year–1 for FEV1. We confirm the variable distribution of FEV1 decline and found that longer follow-up periods reduce this variability. Of note, FEV1 decline was different between groups (shorter: 19.7 [180.4] vs longer: –9.7 [46.9]; p = 0.018). Further, our data revealed differences in the clinical presentation according to follow-up times, with special emphasis on dyspnea (OR: 1.035; 95%CI: 1.014–1.056), exacerbations (OR 1.172; 95%CI 1.045–1.315) and CAT scores (OR 1.047; 95%CI 1.019–1.075) being associated with longer follow-up times. Conclusions: This study describes the impact of follow-up periods on lung function variability, and reveals differences in clinical presentation according to follow-up times, with special emphasis on dyspnea, exacerbations and CAT scores.

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Section: Discussioncontrasting

confidence: 56%

Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort

Lόpez-Campos

Fernández-Villar

Represas-Represas

et al. 2017

European Clinical Respiratory Journal

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“…The changes could also be due to better implementations of COPD guidelines and better discrimination of the separate disease entities asthma and COPD, resulting in decreased ICS or LABA + ICS treatment without concomitant LAMA. The rationale for not treating COPD with ICS without concomitant LABA is well documented [7], and LAMA is the first choice of maintenance treatment with effects on both exacerbation risk and symptoms [1,22]. During the most recent years, the benefits of combining LAMA and LABA have been emphasized [23].…”

Section: Discussionmentioning

confidence: 99%

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Sundh

Åberg

Hasselgren

et al. 2017

European Clinical Respiratory Journal

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Introduction: The aim was to investigate how the pattern of pharmacological treatment in Swedish patients with chronic obstructive pulmonary disease (COPD) has changed over a decade, and to identify factors associated with treatment. Methods: Data on patient characteristics and pharmacological treatment were collected using questionnaires from two separate cohorts of randomly selected primary and secondary care patients with a doctor’s diagnosis of COPD in central Sweden, in 2005 (n = 1111) and 2014 (n = 1329). Cross-tabulations and chi-square tests were used to compare maintenance treatment in 2005 and 2014, and to investigate the distribution of treatment by the 2017 Global Initiative for Obstructive Lung Disease (GOLD) ABCD groups. Multinomial logistic regression was used to analyze associations with the major types of recommended treatments: bronchodilator therapy, combined long-acting beta-2-antagonists (LABA) + inhaled corticosteroids (ICS), and triple inhaled therapy. Results: The proportion of patients with no maintenance treatment, with only LABA + ICS, and with sole ICS statistically significantly decreased (36 vs. 31%, 16 vs. 12% and 5 vs. 2%, respectively), and the proportion with triple inhaled therapy statistically significantly increased (29 vs. 40%). In 2014, triple inhaled therapy was the most common treatment in all GOLD groups except group A. In 2014, previous frequent exacerbations [OR (95% CI) 2.34 (1.62 to 3.36)], worse COPD Assessment Test score [1.07 (1.05 to 1.09)], female sex [2.13 (1.56 to 2.91)], and access to a specific responsible doctor [1.95 (1.41 to 2.69)] were associated with triple inhaled therapy. Current smoking [0.40 (0.28 to 0.57)] and overweight [0.62 (0.41 to 0.93)] were inversely associated with triple inhaled therapy. Conclusions: Over the last decade, triple inhaled therapy has increased, and no maintenance treatment, ICS, or LABA + ICS has decreased. Triple inhaled therapy is the most common treatment and is associated with previous exacerbations, higher symptom level, female sex, and having a specific responsible doctor.

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“…especially in those with severe and very severe COPD. 2,3 However, even when prescribed, low adherence to these maintenance medications among patients in the real world could offset the benefit reported in randomized controlled trials.…”

Section: What Is the Major Question?mentioning

confidence: 99%

Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

et al. 2014

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OBJECTIVE:We tested the hypothesis that use of and adherence to maintenance medication is low among individuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD. DESIGN AND PARTICIPANTS: We identified 5,812 individuals with COPD from the Copenhagen General Population Study, and classified them according to the Global Initiative for Obstructive Lung Disease (GOLD) airflow limitation grades 1-4. Dispensing of fixed-dose combinations of inhaled corticosteroids with long-acting beta 2 -agonists, long-acting anti-cholinergics, or long-acting beta 2 -agonists was identified in a nationwide registry. Use of medication was defined as medication dispensed during a one-year period , and adherence was calculated from dosages available in one year. KEY RESULTS: Use of fixed-dose combinations of inhaled corticosteroids with long-acting beta 2 -agonists varied from 2 % to 61 % (p<0.001, test for trend), long-acting anti-cholinergics varied from 0.4 % to 36 % (p<0.001), and long-acting beta 2 -agonists varied from 0.3 % to 11 % (p<0.001. Among utilizers of these medications, adherence varied from 29 % to 56 % (p<0.001, test for trend) across GOLD 1-4 for fixed-dose combinations of inhaled corticosteroids with long-acting beta 2 -agonists, from 51 % to 68 % (p=0.11) for long-acting anti-cholinergics, and from 25 to 62 % (p=0.01) for long-acting beta 2 -agonists. CONCLUSIONS: Use of and adherence to maintenance medication for COPD in the general population was associated with the severity of COPD as defined by GOLD, but even in severe and very severe COPD, use and adherence was low.

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A 4-Year Trial of Tiotropium in Chronic Obstructive Pulmonary Disease

Cited by 1,988 publications

References 23 publications

Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort

Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

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