1
|
Egenod T, Deslee G, Degano B. [Bronchoscopic COPD treatments]. Rev Mal Respir 2023; 40:820-833. [PMID: 37684196 DOI: 10.1016/j.rmr.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/18/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with disabling respiratory symptoms including dyspnea, frequent exacerbations and chronic bronchitis. The currently available pharmacological and non-pharmacological therapies have limited efficacy, necessitating the development of interventional strategies, many of them endoscopic. STATE OF THE ART Endoscopic lung volume reduction has markedly increased over recent years, principally as regards the endobronchial valves currently used in routine care. Indeed, multiple randomized trials have demonstrated a significant clinical benefit in a selected population identifiable due to the absence of interlobar collateral ventilation. Other endoscopic volume reduction techniques (polymers, thermal vapor, spirals) shall require additional studies before being considered as options in routine care. Targeted lung denervation (TLD) has aroused interest as a means of reducing exacerbations in the early phases of relevant studies. Endobronchial techniques (bronchoscopic cryospray, bronchial rheoplasty) are still at a very early stage of development, which is aimed at reducing the symptoms of chronic bronchitis. OUTLOOK Aside from endobronchial valves, which are currently employed in routine care, all the above-mentioned endoscopic techniques require additional studies in order to determine their benefit/risk balance and to identify the population that would benefit the most. CONCLUSIONS Endoscopic treatments constitute a major avenue of research and innovation in the therapeutic management of COPD. Inclusion of patients in disease registries and clinical trials remains essential, the objective being to gauge the interest of these treatments and their future role in everyday COPD management.
Collapse
Affiliation(s)
- T Egenod
- Alpes, Inserm 1300, Grenoble, France.
| | - G Deslee
- Service de pneumologie, hôpital universitaire Dupuytren, Limoges, France
| | - B Degano
- Service de pneumologie, hôpital Maison Blanche, Inserm UMRS-1250, université Reims Champagne Ardenne, Reims, France
| |
Collapse
|
2
|
Shiwaku E, Dote S, Kaneko S, Hei C, Aikawa M, Sakai Y, Kawai T, Iwatsubo S, Hashimoto M, Tsuneishi T, Nishimura T, Iwata T, Hira D, Terada T, Nishimura T, Kobayashi Y. Pharmacist involvement in the inhaler choice improves lung function in patients with COPD: a prospective single-arm study. J Pharm Health Care Sci 2021; 7:28. [PMID: 34334137 PMCID: PMC8327440 DOI: 10.1186/s40780-021-00211-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background Currently, in Japan, shifting tasks from physician to hospital pharmacist is being developed to reduce physician workload and improve the quality of pharmacotherapy. This study aimed to investigate the effects of pharmacist involvement in the choice of inhaler as the task on the clinical outcomes of patients with chronic obstructive pulmonary disease (COPD). Methods This prospective, single-center, single-arm study included 36 outpatients with newly diagnosed COPD indicating inhaler therapy. Eligible patients were immediately interviewed by pharmacist. Then, pharmacist assessed patient’s inhalation flow rate, physical function to handle an inhaler, comprehension, and value, and finally recommended a personalized inhaler based on originally developed inhaler choice protocol, and pulmonologist prescribed a pharmacist-selected inhaler. The primary endpoint was the improvement in trough forced expiratory volume in 1 s (FEV1) between baseline and week 26. The secondary endpoints were safety, and improvements at week 26 in scores for the COPD Assessment Test (CAT), modified British Medical Research Council Dyspnea Scale (mMRC), and Adherence Starts with Knowledge-20 (ASK-20). Results The pneumonologists completely agreed with the pharmacist-recommended inhaler. Mean FEV1 significantly increased from baseline to week 26 (1.60, SD 0.54 L vs. 1.98, SD 0.56 L; p < 0.0001). Significant improvements in CAT, mMRC, and ASK-20 scores were also observed. The prevalence of CAT responders as a negative predictor of acute exacerbation, defined as those with a decrease in CAT score of ≥2 points from baseline, was 86%. None of the patients experienced exacerbation during the study period. Conclusions Pharmacist involvement in the choice of inhaler for patients with newly diagnosed COPD was associated with improved lung function, health status, clinical symptoms, and adherence to inhaler therapy. Shifting task of choosing appropriate inhaler from physician to hospital pharmacist may be performed effectively and safely with an inhaler choice protocol. Trial registration number UMIN000039722, retrospectively registered on March 10, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s40780-021-00211-0.
Collapse
Affiliation(s)
- Eiji Shiwaku
- Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Satoshi Dote
- Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan.
| | - Shinobu Kaneko
- Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Chisato Hei
- Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Masaki Aikawa
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Yuki Sakai
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Takahiro Kawai
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Shigeaki Iwatsubo
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | | | - Teppei Tsuneishi
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Tomoko Nishimura
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Toshiyuki Iwata
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Daiki Hira
- Department of Pharmacy, Shiga University of Medical Science Hospital, Shiga, Japan.,College of Pharmaceutical Sciences, Ritsumeikan University, Shiga, Japan
| | - Tomohiro Terada
- Department of Pharmacy, Shiga University of Medical Science Hospital, Shiga, Japan
| | - Takashi Nishimura
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Yuka Kobayashi
- Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan
| |
Collapse
|
3
|
Takahashi K, Uchida M, Kato G, Takamori A, Kinoshita T, Yoshida M, Tajiri R, Kojima K, Inoue H, Kobayashi H, Sadamatsu H, Tashiro H, Tanaka M, Hayashi S, Kawaguchi A, Kimura S, Sueoka-Aragane N, Kawayama T. First-Line Treatment with Tiotropium/Olodaterol Improves Physical Activity in Patients with Treatment-Naïve Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:2115-2126. [PMID: 32982204 PMCID: PMC7501469 DOI: 10.2147/copd.s268905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background Comparative effects on physical activity of mono and dual bronchodilators remain unclear in patients with treatment-naïve chronic obstructive pulmonary disease (COPD). We sought to compare the changes in physical activity before and after tiotropium and tiotropium/olodaterol treatment in treatment-naïve COPD patients. Methods A prospective, multicenter, randomized, open-labeled, and parallel interventional study was conducted. Eighty Japanese patients with treatment-naïve COPD were randomized to receive either tiotropium or tiotropium/olodaterol treatment for 12 weeks. Spirometry and dyspnea index were assessed, and COPD assessment test (CAT) and the 6-minute walk distance (6MWD) were conducted before and after treatment. Evaluation of physical activity was assessed by a triaxle accelerometer over a 2-week period before and after treatment. Results There were no differences in the mean age (69.8 vs 70.4 years), body mass index (BMI) (22.5 vs 22.6 kg/m2) and mean % forced expiratory volume in 1 second (%FEV1) at baseline (61.5 vs 62.6%) between the two groups. Changes in FEV1 (mean±standard error, 242.8±28.8 mL) and transient dyspnea index (TDI) (2.4±0.3 points) before and after tiotropium/olodaterol treatment were greater than with tiotropium treatment (104.1±31.9 mL, p<0.01 and 1.5±0.3, p=0.02, respectively). Changes in the duration of physical activity with 1.0–1.5 metabolic equivalents (METs) estimated in the sedentary position following tiotropium/olodaterol treatment (−38.7±14.7 min) tended to be reduced more than with tiotropium treatment (−4.6±10.6 min) (p=0.06), although those with ≥2.0 METs numerically increased with both treatments (+10.8±7.6 min for tiotropium/olodaterol vs +8.3±7.6 min for tiotropium, p=0.82). Tiotropium/olodaterol treatment reduced the duration of physical activity with 1.0–1.5 METs (regression coefficient, −43.6 [95% CI −84.1, −3.1], p=0.04) in a multiple regression model adjusted for cofounding factors such as age, FEV1, total CAT scores, 6MWD, and TDI. Conclusion This is the first study to report the impact of dual bronchodilator on physical activity in treatment-naïve COPD patients of Japanese with low BMI.
Collapse
Affiliation(s)
- Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaru Uchida
- Division of Internal Medicine, Japan Community Health Care Organization Saga Central Hospital, Saga, Japan
| | - Go Kato
- Division of Respiratory Medicine, Saga Prefectural Medical Center Koseikan, Saga, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, Faculty of Medicine, Saga University, Saga, Japan
| | - Takashi Kinoshita
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Makoto Yoshida
- Division of Respiratory Medicine, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Ryo Tajiri
- Clinical Research Center, Saga University Hospital, Faculty of Medicine, Saga University, Saga, Japan
| | - Keisuke Kojima
- Division of Internal Medicine, Imari Arita Kyouritsu Hospital, Saga, Japan
| | - Hiroshi Inoue
- Division of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Hiromi Kobayashi
- Division of Respiratory Medicine, National Hospital Organization East Saga Hospital, Saga, Japan
| | - Hironori Sadamatsu
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Masahide Tanaka
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shinichiro Hayashi
- Division of Internal Medicine, Kouhoukai Takagi Hospital, Fukuoka, Japan
| | - Atsushi Kawaguchi
- Clinical Research Center, Saga University Hospital, Faculty of Medicine, Saga University, Saga, Japan.,Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | | |
Collapse
|
4
|
Buhl R, Singh D, de la Hoz A, Xue W, Ferguson GT. Benefits of Tiotropium/Olodaterol Compared with Tiotropium in Patients with COPD Receiving only LAMA at Baseline: Pooled Analysis of the TONADO ® and OTEMTO ® Studies. Adv Ther 2020; 37:3485-3499. [PMID: 32462607 PMCID: PMC7370969 DOI: 10.1007/s12325-020-01373-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report recommends long-acting muscarinic antagonists (LAMA) or long-acting β2-agonists (LABA) as first-line treatment for chronic obstructive pulmonary disease (COPD), but many patients remain symptomatic on monotherapy and escalation to dual-bronchodilator therapy may be warranted. METHODS TONADO® 1&2 and OTEMTO® 1&2 assessed lung function and patient-reported outcomes in patients with moderate-to-severe (OTEMTO) or moderate-to-very-severe (TONADO) COPD. This pooled post hoc analysis included patients treated with LAMA monotherapy at baseline who were randomised to receive either 5 µg tiotropium (LAMA) or 5/5 µg tiotropium/olodaterol (LAMA/LABA). We assessed changes from baseline and responder rates for trough forced expiratory volume in 1 s (FEV1), St. George's Respiratory Questionnaire (SGRQ) and the Transition Dyspnoea Index (TDI). RESULTS Overall, 151 patients received tiotropium; 148 received tiotropium/olodaterol. Mean differences from baseline with tiotropium/olodaterol versus tiotropium were + 0.074 l (95% confidence interval [CI] 0.033, 0.115; P = 0.0004) for trough FEV1, - 2.675 (95% CI - 5.060, - 0.291; P = 0.0280) for SGRQ and 1.148 (95% CI 0.564, 1.732; P = 0.0001) for TDI. Patients were more likely to respond when treated with tiotropium/olodaterol versus tiotropium for trough FEV1 (odds ratio [OR] 3.14, 95% CI 1.94, 5.06; P < 0.0001), SGRQ (OR 1.49, 95% CI 0.93, 2.40; P = 0.0980) and TDI (OR 2.81, 95% CI 1.71, 4.60; P < 0.0001). Minimum clinically important difference from baseline in any of the analysed outcomes (FEV1 ≥ 0.1 l, SGRQ ≥ 4.0 points or TDI ≥ 1.0 point) was more likely in patients treated with tiotropium/olodaterol versus tiotropium (OR 2.43, 95% CI 1.32, 4.51; P = 0.0046). CONCLUSION In patients with COPD receiving only LAMA monotherapy, treatment escalation to tiotropium/olodaterol resulted in statistically significant and clinically relevant improvements in lung function, health status and breathlessness. These results support early therapy optimisation to dual bronchodilation with tiotropium/olodaterol in patients receiving tiotropium alone. TRIAL REGISTRATION TONADO® 1 was registered in the US National Library of Medicine on 9 September 2011 (Clinicaltrials.gov: NCT01431274). TONADO® 2 was registered in the US National Library of Medicine on 9 September 2011 (Clinicaltrials.gov: NCT01431287). OTEMTO® 1 was registered in the US National Library of Medicine on 17 October 2013 (Clinicaltrials.gov: NCT01964352). OTEMTO® 2 was registered in the US National Library of Medicine on 10 December 2013 (Clinicaltrials.gov: NCT02006732).
Collapse
Affiliation(s)
- Roland Buhl
- Pulmonary Department, Johannes Gutenberg University Hospital, Mainz, Germany.
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Alberto de la Hoz
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Wenqiong Xue
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
| |
Collapse
|
5
|
Montes de Oca M, López Varela MV, Acuña A, Schiavi E, Casas A, Tokumoto A, Torres Duque CA, Ramírez-Venegas A, García G, Camelier A, Bergna M, Cohen M, Sanchez-Angarita E, Guzmán S, Czischke K, Barros M, Rey A. Incorporating New Evidence on Inhaled Medications in COPD. The Latin American Chest Association (ALAT) 2019. Arch Bronconeumol 2019; 56:106-113. [PMID: 31767208 DOI: 10.1016/j.arbres.2019.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/30/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023]
Abstract
This document on COPD from the Latin American Chest Association (ALAT-2019) uses PICO methodology to analyze new evidence on inhaled medication and answer clinical questions. The following key points emerged from this analysis: 1) evidence is lacking on the comparison of short-acting vs. long-acting bronchodilators in patients with mild COPD; patients with moderate-to-severe COPD obtain greater benefit from long-acting bronchodilators; 2) the benefits of monotherapy with long-acting antimuscarinic agents (LAMA) and combined therapy with long-acting β2-agonists and inhaled corticosteroids (LABA/ICS) are similar, although the latter is associated with a greater risk of pneumonia; 3) LABA/LAMA offer greater benefits in terms of lung function and risk of exacerbation than LABA/ICS (the latter involve an increased risk of pneumonia), 4) LAMA/LABA/ICS have greater therapeutic benefits than LABA/LAMA on the risk of moderate-severe exacerbations. With regard to the role of eosinophils in guiding the use of ICS, ICS withdrawal must be considered when the initial indication was wrong or no response is elicited, in patients with side effects such as pneumonia, and in patients with a low risk of exacerbation and an eosinophil blood count of <300 cells/μl. All this evidence, categorized according to the severity of the obstruction, symptoms, and risk of exacerbations, has been used to generate an algorithm for the use of inhaled medication in COPD.
Collapse
Affiliation(s)
- María Montes de Oca
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela.
| | | | - Agustín Acuña
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela; Departamento de Investigación y Estadística, ITSalud/Medsolid, Caracas, Venezuela
| | - Eduardo Schiavi
- SubSecretaría de Planificación Sanitaria, Ministerio de Salud, Gobierno de la Ciudad Autónoma de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | | | | | - Aquiles Camelier
- Universidade do Estado da Bahia e Escola Bahiana de Medicina, Salvador, Brasil
| | - Miguel Bergna
- Hospital Dr. Antonio Cetrángolo, Vicente López, Buenos Aires, Argentina
| | - Mark Cohen
- Hospital Centro Médico, Guatemala, Guatemala
| | - Efraín Sanchez-Angarita
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela; Departamento de Investigación y Estadística, ITSalud/Medsolid, Caracas, Venezuela
| | | | - Karen Czischke
- Clínica Alemana de Santiago, Hospital Padre Hurtado, Universidad del Desarrollo, San Ramón, Región Metropolitana, Chile
| | - Manuel Barros
- Escuela de Medicina, Universidad de Valparaíso, Hospital C. Van Buren, Valparaíso, Región de Valparaíso, Chile
| | - Alejandra Rey
- Universidad de la República, Hospital Maciel, Montevideo, Uruguay
| |
Collapse
|
6
|
Malerba M, Foci V, Patrucco F, Pochetti P, Nardin M, Pelaia C, Radaeli A. Single Inhaler LABA/LAMA for COPD. Front Pharmacol 2019; 10:390. [PMID: 31105560 PMCID: PMC6494943 DOI: 10.3389/fphar.2019.00390] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/29/2019] [Indexed: 01/04/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common disabling disease characterized by progressive airflow obstruction. Great efforts were spent in the development of drugs able to improve symptoms, quality of life, reduce exacerbations, hospitalizations and the frequency of death of patients with COPD. The cornerstones of treatment are bronchodilator drugs of two different classes: beta agonists and muscarinic antagonists. Currently the Global initiative for COPD suggests the use of long acting beta agonists (LABAs) and long acting muscarinic antagonists (LAMAs) in combination for the majority of COPD patients, thus great interest is associated with the developing of LAMA/LABA fixed combination in the maintenance treatment of stable COPD. Many LAMA/LABA fixed dose combinations have been licensed in different countries and the clinical use of these drugs stimulated the performance of many clinical trials. The purpose of this review is a complete criticism of pharmacological and clinical aspects related to the use of LAMA/LABA single inhalers for the maintenance treatment of stable COPD, with particular mention to the most debated topics and future prospects in the field.
Collapse
Affiliation(s)
- Mario Malerba
- Respiratory Medicine, Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy.,Respiratory Unit, Sant'Andrea Hospital, Vercelli, Italy
| | - Valentina Foci
- Respiratory Medicine, Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy.,Respiratory Unit, Sant'Andrea Hospital, Vercelli, Italy
| | - Filippo Patrucco
- Respiratory Medicine, Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy.,Respiratory Unit, Sant'Andrea Hospital, Vercelli, Italy
| | - Patrizia Pochetti
- Respiratory Medicine, Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy.,Respiratory Unit, Sant'Andrea Hospital, Vercelli, Italy
| | - Matteo Nardin
- Department of Medicine, Spedali Civili di Brescia, Brescia, Italy
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | | |
Collapse
|
7
|
Derom E, Brusselle GG, Joos GF. The once-daily fixed-dose combination of olodaterol and tiotropium in the management of COPD: current evidence and future prospects. Ther Adv Respir Dis 2019; 13:1753466619843426. [PMID: 31002020 PMCID: PMC6475840 DOI: 10.1177/1753466619843426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
Long-acting bronchodilators are the cornerstone of pharmacologic treatment of chronic obstructive pulmonary disease (COPD). Spiolto® or Stiolto® is a fixed-dose combination (FDC) containing two long-acting bronchodilators, the long-acting muscarinic receptor antagonist tiotropium (TIO) and the long-acting β2-adrenoceptor agonist olodaterol (OLO), formulated in the Respimat® Soft Mist™ inhaler. A total of 13 large, multicentre studies of up to 52 weeks' duration have documented its efficacy in more than 15,000 patients with COPD. TIO/OLO 5/5 µg FDC significantly increases pulmonary function compared with placebo and its respective constituent mono-components TIO 5 µg and OLO 5 µg. TIO/OLO 5/5 µg also results in statistically and clinically significant improvements in patient-reported outcomes, such as dyspnoea, use of rescue medication, and health status. Addition of OLO 5 µg to TIO 5 µg reduces the rate of moderate-to-severe exacerbations by approximately 10%. Compared with placebo and TIO 5 µg, TIO/OLO 5/5 µg significantly improves exercise capacity (e.g. endurance time) and physical activity, the latter increase being reached by a unique combination behavioural modification intervention, dual bronchodilatation and exercise training. Overall, the likelihood for patients to experience a clinically significant benefit is higher with TIO/OLO 5/5 µg than with its constituent mono-components, which usually yield smaller improvements which do not always reach statistical significance, compared with baseline or placebo. This supports the early introduction of TIO/OLO 5/5 µg in the management of patients with symptomatic COPD.
Collapse
Affiliation(s)
- Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Ingang 12, Route 1404, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Guy G. Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Guy F. Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
8
|
Ferguson GT, Dalby RN. Clinical implications of the tiotropium/olodaterol inhaler for patients with chronic obstructive pulmonary disease. Postgrad Med 2018; 130:515-522. [DOI: 10.1080/00325481.2018.1481713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Gary T. Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
| | - Richard N. Dalby
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| |
Collapse
|
9
|
Miravitlles M, Urrutia G, Mathioudakis AG, Ancochea J. Efficacy and safety of tiotropium and olodaterol in COPD: a systematic review and meta-analysis. Respir Res 2017; 18:196. [PMID: 29178871 PMCID: PMC5702233 DOI: 10.1186/s12931-017-0683-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/15/2017] [Indexed: 11/25/2022] Open
Abstract
Background Long-acting bronchodilators are the cornerstone of pharmacologic treatment of COPD. The new combination of long-acting muscarinic antagonist (LAMA) tiotropium (TIO) and long acting beta-agonists (LABA) olodaterol (OLO) has been introduced as fist line therapy for COPD. This article analyses the evidence of efficacy and safety of the TIO/OLO combination. Methods A systematic review and metaanalysis of randomized controlled trials (RCT) with a period of treatment of at least 6 weeks, in patients with COPD confirmed by spirometry, comparing combined treatment with TIO/OLO (approved doses only), with any of the mono-components or any other active comparator administered as an inhalator. Results A total of 10 Randomized controlled trials (RCT) were identified (N = 10,918). TIO/OLO significantly improved trough FEV1 from baseline to week 12 versus TIO, OLO and LABA/ICS (0.06 L, 0.09 L and between 0.04 and 0.05 L, respectively). TIO/OLO improved transitional dyspnea index (TDI) and St. George’s Respiratory Questionnaire (SGRQ) compared with mono-components, with patients more likely to achieve clinically important improvements in TDI (risk ratio [RR]: 1.17, 95% confidence interval [CI]: [1.07, 1.28] versus TIO and RR: 1.14, 95%CI: [1.01, 1.28] versus OLO) and in SGRQ (RR: 1.21, 95%CI: [1.12, 1.30] versus TIO and RR: 1.28, 95%CI: [1.18, 1.40] versus OLO). Patients treated with TIO/OLO showed a significant reduction in the use of rescue medication and no significant differences in frequency of general and serious adverse events were observed between TIO/OLO and mono-components. Conclusions Treatment with TIO/OLO provided significant improvements in lung function versus mono-components and LABA/ICS with more patients achieving significant improvements in dyspnea and health status. No differences in adverse events were observed compared with other active treatments. Clinical trial registration PROSPERO register of systematic reviews (CRD42016040162). Electronic supplementary material The online version of this article (10.1186/s12931-017-0683-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron., P. Vall d'Hebron 119-129, ES-08035, Barcelona, Spain.
| | - Gerard Urrutia
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau). CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, University Hospital of South Manchester, The University of Manchester, Manchester, UK
| | - Julio Ancochea
- Pneumology Department, Hospital Universitario de La Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP) Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
10
|
Fernandes FLA, Cukier A, Camelier AA, Fritscher CC, da Costa CH, Pereira EDB, Godoy I, Cançado JED, Romaldini JG, Chatkin JM, Jardim JR, Rabahi MF, de Nucci MCNM, Sales MDPU, Castellano MVCDO, Aidé MA, Teixeira PJZ, Maciel R, Corrêa RDA, Stirbulov R, Athanazio RA, Russo R, Minamoto ST, Lundgren FLC. Recommendations for the pharmacological treatment of COPD: questions and answers. J Bras Pneumol 2017; 43:290-301. [PMID: 29365005 PMCID: PMC5687967 DOI: 10.1590/s1806-37562017000000153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/04/2017] [Indexed: 11/22/2022] Open
Abstract
The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities.
Collapse
Affiliation(s)
- Frederico Leon Arrabal Fernandes
- . Divisão de Pneumologia, Instituto do Coração - InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Alberto Cukier
- . Divisão de Pneumologia, Instituto do Coração - InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Aquiles Assunção Camelier
- . Universidade do Estado da Bahia - UNEB - Salvador (BA) Brasil
- . Escola Bahiana de Medicina e Saúde Pública, Salvador (BA) Brasil
| | - Carlos Cezar Fritscher
- . Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS− Porto Alegre (RS)Brasil
| | | | | | - Irma Godoy
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | | | - José Gustavo Romaldini
- . Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo,São Paulo (SP) Brasil
| | - Jose Miguel Chatkin
- . Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS− Porto Alegre (RS)Brasil
| | - José Roberto Jardim
- . Faculdade de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | | | | | | | | | - Miguel Abidon Aidé
- . Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Paulo José Zimermann Teixeira
- . Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
- . Universidade FEEVALE, Campus II, Novo Hamburgo (RS) Brasil
| | - Renato Maciel
- . Disciplina de Pneumologia, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Ricardo de Amorim Corrêa
- . Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Roberto Stirbulov
- . Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo,São Paulo (SP) Brasil
| | - Rodrigo Abensur Athanazio
- . Divisão de Pneumologia, Instituto do Coração - InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Rodrigo Russo
- . Departamento de Medicina, Universidade Federal de São João Del Rei - UFSJ − São João Del Rei (MG) Brasil
| | - Suzana Tanni Minamoto
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | | |
Collapse
|
11
|
Affiliation(s)
- Antonio Anzueto
- Pulmonology Section, University of Texas Health Science Center, San Antonio, TX, USA
- South Texas Veterans Health Care System, Department of Medicine, Pulmonary Section, San Antonio, TX, USA
| | - Marc Miravitlles
- Pneumonology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| |
Collapse
|