Efeito de curto prazo do tiotrópio nos portadores de DPOC em tratamento com β2-agonista

Abstract

Objective: To evaluate the short-term impact of tiotropium in patients with severe or very severe COPD who complain of dyspnea despite being currently treated with other bronchodilators. Methods: A prospective study including patients with severe or very severe COPD and complaining of dyspnea at rest or on minimal exertion. Every 15 days, the bronchodilator treatment regimen was altered, from salmeterol to tiotropium to salmeterol+tiotropium. At the end of each regimen, pulmonary function tests and the six-minute walk test (6MWT) were performed. The degree of dyspnea and the ability to perform activities of daily living were also assessed. To evaluate patient ability to perform activities of daily living, we employed the London Chest Activity of Daily Living (LCADL), validated for use in Brazil. Results: We evaluated 52 patients, 30 of whom completed the study. The use of tiotropium in isolation resulted in significant improvement in dyspnea at baseline (mean Medical Research Council scale score reduced from 3.0 to 2.5) and at the end of 6MWT (mean Borg scale score reduced from 6.1 to 4.5), and the differences were significant (p < 0.05 for both). The use of the salmeterol+tiotropium combination resulted in a significant (81 mL) increase in FEV 1 and a 5.7 point improvement in the LCADL score. Conclusions: The introduction of tiotropium into the treatment of patients with severe or very severe COPD and using long-acting β 2 agonists improves pulmonary function and provides symptomatic relief, as perceived by patients in the short term. These results, obtained under real life treatment conditions, support the use of the salmeterol+tiotropium combination in specific treatment protocols for these patients.Keywords: Pulmonary disease, chronic obstructive; Bronchodilator agents; Dyspnea; Activities of daily living. ResumoObjetivo: Avaliar o impacto de curto prazo do uso de tiotrópio em pacientes com DPOC grave e muito grave com queixas de dispneia apesar do tratamento com outros broncodilatadores. Métodos: Estudo prospectivo incluindo pacientes com DPOC grave ou muito grave, com queixa de dispneia de pequenos esforços ou ao repouso. A cada 15 dias, o tratamento broncodilatador foi modificado: salmeterol, tiotrópio e associação salmeterol+tiotrópio. Ao final de cada regime, foram realizados testes de função pulmonar e teste de caminhada de seis minutos (TC6). Também foram avaliados o grau de dispneia e a capacidade de realização de atividades de vida diária. Para a avaliação das atividades de vida diária, foi utilizada a escala London Chest Activity of Daily Living (LCADL) validado para uso no Brasil. Resultados: Foram avaliados 52 pacientes. Desses, 30 completaram o estudo. A introdução de tiotrópio como monoterapia resultou em uma melhora significativa (p < 0,05) da dispneia basal (média do escore da escala do Medical Research Council de 3,0 para 2,5) e ao final do TC6 (média do escore da escala de Borg de 6,1 para 4,5), e as diferenças foram significativas (p < 0,05 para ambos). O uso da associação salmeter...

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“…Tiotropium is the most studied pharmacological agent, and COPD studies have indicated satisfactory results, including a reduction in the number of exacerbations, an improvement in quality of life and an increase in the FEV1 (99). There is no evidence that supports the superiority of LAMAs over LABAs; however, the combination of these drugs may be used with an additive effect in patients with accentuated lung function or significant functional limitations (100). Recently, the use of tiotropium in asthma has been studied as an alternative in patients with contraindications to the use or in combination with LABAs (101).…”

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“…Fernandes et al89 evaluated the short-term impact of tiotropium in patients with severe or very severe COPD who complain of dyspnea despite being currently treated with other bronchodilators and claim that the introduction of tiotropium into the treatment of such patients using long-acting beta(2) agonists improves pulmonary function and provides symptomatic relief, as perceived by patients in the short term. They claim that these results, obtained under real life treatment conditions, support the use of the salmeterol+tiotropium combination in specific treatment protocols for these patients.…”

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“…The importance of tiotropium bromide in the treatment of COPD has also been demonstrated in various randomized trials and in a real-life study. (6) The combination of tiotropium bromide, which is a bronchodilator classified as a LAMA, is beneficial in patients with severe and very severe COPD. The use of a LAMA alone as an initial treatment or its association with a LABA is indicated in patients with COPD and moderate obstructive lung disease.…”

“…In addition, exacerbations should be prevented and treated, reducing the number of hospitalizations. (2,5,6) Non-pharmacological and pharmacological treatment is established in accordance with national and international guidelines, (2,7) the pillars of treatment being the use of long-acting bronchodilators. The evolution in the knowledge of the disease and in clinical research resulted in the introduction of new drugs for the treatment of COPD.…”