Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease with Tiotropium, a Once-Daily Inhaled Anticholinergic Bronchodilator

Abstract

Tiotropium reduces COPD exacerbations and may reduce related health care utilization in patients with moderate to severe COPD.

Patient-level pooled analysis of the effect of tiotropium on COPD exacerbations and related hospitalisations

“…[10][11][12][13][14][15]17 At the time of manuscript finalisation, this dataset reflected all completed studies that match the inclusion criteria.…”

“…8,9 Tiotropium (Spiriva ® ) has been previously demonstrated to reduce the risk of exacerbations and associated hospitalisations in individual trials as secondary outcomes, [10][11][12][13][14] and more recently as a primary outcome. 15 As these trials were available in the same database, this has provided an important opportunity to assess in more detail the effects of tiotropium on these outcomes in comparison with placebo.…”

Superiority of "triple" therapy with salmeterol/fluticasone propionate and tiotropium bromide versus individual components in moderate to severe COPD

“…3 4 These effects are associated with a reduction in exacerbation rates. 5 The long acting beta agonist (LABA) salmeterol is an alternative inhaled bronchodilator therapy and is often prescribed in a combination inhaler with the anti-inflammatory corticosteroid fluticasone propionate (FP). [6][7][8][9] This combination of salmeterol and FP (SFC) has demonstrated a broad range of anti-inflammatory effects 10 that are greater than those seen with inhaled corticosteroid (ICS) monotherapy 11 and the likely explanation for this is a molecular interaction (synergy) between the LABA and ICS.…”

Azithromycin for Prevention of Exacerbations of COPD

“…19 At each clinic visit and telephone contact, study personnel determined whether an acute exacerbation of COPD had occurred in the previous month. The date of each acute exacerbation was taken as the date treatment was prescribed.…”

“…[1][2][3][4][5] Patients who have acute exacerbations of COPD, as compared with patients with COPD who do not have acute exacerbations, have an increased risk of death, a more rapid decline in lung function, and reduced quality of life. [6][7][8][9][10][11] Although inhaled glucocorticoids, long-acting beta 2 -agonists, and long-acting muscarinic antagonists reduce the frequency of acute exacerbations of COPD, [12][13][14][15][16][17][18][19][20][21][22][23][24] patients receiving all three of these medications may still have as many as 1.4 acute exacerbations, on average, each year. 23 Macrolide antibiotics have immunomodulatory, antiinflammatory, and antibacterial effects.…”