Tiotropium in chronic obstructive pulmonary disease – a review of clinical development

Abstract

Background: Bronchodilators are the mainstay of pharmacological treatment in chronic obstructive pulmonary disease (COPD), and long-acting muscarinic antagonist (LAMA) monotherapy is recommended as initial treatment for Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups B, C, and D. Main body: Tiotropium bromide was the first LAMA available for COPD in clinical practice and, because of its long duration of action, is administered once daily. Tiotropium was initially available as an inhalation powder delivered via a dry-powder inhaler (DPI). Later, tiotropium also became available as an inhalation spray delivered via a soft mist inhaler (SMI). The SMI was designed to overcome or minimize some of the issues associated with other inhaler types (eg, the need for strong inspiratory airflow with DPIs). Results of short-and long-term randomized, controlled clinical trials of tiotropium in patients with COPD indicated tiotropium was safe and significantly improved lung function, health-related quality of life, and exercise endurance, and reduced dyspnea, lung hyperinflation, exacerbations, and use of rescue medication compared with placebo or active comparators. These positive efficacy findings triggered the evaluation of tiotropium in fixed-dose combination with olodaterol (a long-acting β 2-agonist). In this review, we provide an overview of studies of tiotropium for the treatment of COPD, with a focus on pivotal studies. Conclusion: Tiotropium is safe and efficacious as a long-term, once-daily LAMA for the maintenance treatment of COPD and for reducing COPD exacerbations. The SMI generates a low-velocity, long-duration aerosol spray with a high fine-particle fraction, which results in marked lung drug deposition. In addition, high inspiratory flow rates are not required.

Efficacy of a Self-Designed Questionnaire for Community Screening of COPD

“…22 Finally, in a study of 131 community health service centers in Shanghai, only 21%were equipped with pulmonary function monitors. 23 Early intervention in COPD can effectively delay disease progression, 24 but low awareness of the disease among residents, poor diagnosis recognition and treatment by primary care physicians, and a shortage of primary medical care resources mean that too few cases of COPD are recognized. In addition, the criteria for diagnoses are not standardized in hospitals.…”

Effect of Yifei-Huoxue Decoction Combined with Tiotropium on Inflammatory Cytokine Levels, Pulmonary Function, and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

“…A large number of previous clinical studies have shown that the bacterial resistance to antibiotics and airway mucus hypersecretion are the main bottlenecks of Western medicine in the treatment of acute and exacerbated COPD. The syndrome investigation with a large sample size has found that 75% of patients belong to the category of the phlegm-heat obstructing lung [ 22 – 24 ]. The TCM prescription formulated according to the symptoms has revealed the mechanisms from the aspects of reducing drug resistance, lowering airway mucus secretion, and enhancing anti-inflammatory effect, and the synergistic effect of TCM prescription with Western medical treatment has been confirmed.…”

Metal–organic frameworks as a therapeutic strategy for lung diseases

“…An inhalation device is a drug delivery tool of inhaled preparations, which has an important influence on the delivery effectiveness and therapeutic efficacy of the drugs to the lungs. Current inhalation devices include pressurized metered dose inhalers (pMDI), 181 dry powder inhalers (DPI), 182 and soft mist inhalers (SMI) 183,184 (Fig. 12).…”