Tiotropium in patients with moderate COPD naive to maintenance therapy: a randomised placebo-controlled trial

The benefits of pharmacotherapy with tiotropium HandiHaler 18 μg for patients with chronic obstructive pulmonary disease (COPD) have been previously demonstrated. However, few data exist regarding the treatment of moderate disease (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II). To determine whether tiotropium improves lung function/patient-reported outcomes in patients with GOLD stage II COPD naive to maintenance therapy. A randomised 24-week double-blind placebo-controlled trial of tiotropium 18 μg once daily (via HandiHaler) was performed in maintenance therapy–naive patients with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7 and post-bronchodilator FEV1 ⩾50 and <80%. A total of 457 patients were randomised (238 tiotropium, 219 placebo; mean age 62 years; FEV1 1.93 l (66% predicted)). Tiotropium was superior to placebo in mean change from baseline in post-dose FEV1 area under the curve from 0 to 3 h (AUC0–3h) at week 24 (primary endpoint): 0.19 vs. −0.03 l (least-squares mean difference 0.23 l, P<0.001). FVC AUC0–3h, trough and peak FEV1 and FVC were significantly improved with tiotropium versus placebo (P<0.001). Compared with placebo, tiotropium provided numerical improvements in physical activity (P=NS). Physician’s Global Assessment (health status) improved (P=0.045) with less impairment on the Work Productivity and Activity Impairment questionnaire (P=0.043) at week 24. The incidence of exacerbations, cough, bronchitis and dyspnoea was lower with tiotropium than placebo. Tiotropium improved lung function and patient-reported outcomes in maintenance therapy–naive patients with GOLD stage II COPD, suggesting benefits in initiating maintenance therapy early. Tiotropium is effective as a first-line maintenance therapy in people with moderate chronic obstructive pulmonary disease (COPD). The once-daily inhaled anticholinergic agent has consistently been shown to provide sustained improvements in lung capacity in people with the condition. An international team led by Thierry Troosters from the Katholieke Universiteit Leuven, Belgium, conducted a randomized, double-blind trial in which they gave 457 patients with stage II COPD, a moderate form of the disease, either tiotropium or placebo for 24 weeks. The patients had not previously received maintenance pharmacotherapy. This was the largest and longest trial so far of tiotropium in patients of this type. Tiotropium proved superior to placebo in various measures of respiratory function. It also reduced COPD symptoms and flare-ups. The findings support beginning maintenance therapy with tiotropium early on in the COPD disease process.