Artigo Acesso aberto Revisado por pares

Rational timing of combination therapy with tiotropium and formoterol in moderate and severe COPD

2008; Elsevier BV; Volume: 102; Issue: 12 Linguagem: Inglês

10.1016/j.rmed.2008.07.012

ISSN

1532-3064

Autores

Claudio Terzano, Angelo Petroianni, Vittoria Conti, Daniela Ceccarelli, Elda Graziani, Alessandro Sanduzzi, Serena D'Avelli,

Tópico(s)

Respiratory Support and Mechanisms

Resumo

AimTo determine which timing of therapy with formoterol (FOR) and/or tiotropium (TIO) shows the greater and more continuous functional improvement during 24 h in patients with moderate to severe COPD.MethodsIn this randomised, blind, crossover study 80 patients with stable COPD (40 moderate and 40 severe) received 5 different bronchodilator 30-day treatments in a random order. Treatments (Tr) were: Tr1: TIO 18 μg once-daily (8 am); Tr2: TIO 18 μg (8 am)+FOR 12 μg (8 pm); Tr3: FOR 12 μg twice-daily (8 am and 8 pm); Tr4: TIO 18 μg (8 am)+FOR 12 μg twice-daily (8 am and 8 pm); Tr5: FOR 12 μg twice-daily (8 am and 8 pm)+TIO 18 μg (8 pm). Spirometries were performed during 24 h (13 steps) on Day1 and Day30. End-points were: gain of FEV1 (ΔFEV1) from baseline of the Day1 and Day30, AUC (Area Under Curve), Dyspnoea Index, and as-needed use of salbutamol.ResultsSixty-eight patients completed all treatments. The greater and continuous daily functional improvement was showed during Tr4 and Tr5 (Day1 +135.8 mL and +119.1 mL; Day30 +160.2 mL, and +160.5 mL, respectively). Daily means of ΔFEV1 were significantly different between single-drug treatments and combination therapy. Dyspnoea was greater in single-drug treatments. Less use of rescue salbutamol was reported in Tr4 (0.80 puffs/die) and Tr5 (0.71 puffs/die).ConclusionsIn patients with moderate to severe COPD, combination therapy with tiotropium administered in the morning (Tr4) was the most effective; in patients with prevailing night-symptoms, treatment with tiotropium in the evening (Tr5) reduced symptoms and use of salbutamol. Tr5 showed less variability of FEV1 during the 24 h (CV=0.256). These results are relevant for opening new ways in clinical practice.

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