Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD

doi:10.1183/09031936.04.00116004

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Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD

D.E. O'Donnell¹, T. Flüge², F. Gerken², A. Hamilton², K. Webb¹, B. Aguilaniu³, B. Make⁴ and H. Magnussen⁵

¹ Respiratory Investigation Unit, Dept of Medicine, Queen's University, Kingston, Canada. ² Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany. ³ UCP-X, Clinique de mail, Grenoble, France. ⁴ National Jewish Medical and Research Center, Denver, USA. ⁵ Krankenhaus Grosshansdorf, Grosshansdorf, Germany

CORRESPONDENCE: D.E. O'Donnell, 102 Stuart Street, Kingston, Canada K7L 2V6. Fax: 1 6135491459. E-mail: odonnell@post.queensu.ca

Keywords: Chronic obstructive pulmonary disease, chronic obstructive pulmonary disease treatment, dyspnoea, exercise tolerance, lung hyperinflation, tiotropium

Received: October 16, 2003
Accepted February 9, 2004

This study was supported by Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany. D.E. O'Donnell holds a career scientist award from the Ontario Ministry of Health.

The aim of this study was to test the hypothesis that use oftiotropium, a new long-acting anticholinergic bronchodilator,would be associated with sustained reduction in lung hyperinflationand, thereby, would improve exertional dyspnoea and exerciseperformance in patients with chronic obstructive pulmonary disease.

A randomised, double-blind, placebo-controlled, parallel-groupstudy was conducted in 187 patients (forced expiratory volumein one second 44±13% pred): 96 patients received 18 µgtiotropium and 91 patients received placebo once daily for 42days. Spirometry, plethysmographic lung volumes, cycle exerciseendurance and exertional dyspnoea intensity at 75% of each patient'smaximal work capacity were compared.

On day 42, the use of tiotropium was associated with the followingeffects at pre-dose and post-dose measurements as compared toplacebo: vital capacity and inspiratory capacity (IC) increased,with inverse decreases in residual volume and functional residualcapacity. Tiotropium increased post-dose exercise endurancetime by 105±40 s (21%) as compared to placebo onday 42. At a standardised time near end-exercise (isotime),IC, tidal volume and minute ventilation all increased, whilstdyspnoea decreased by 0.9±0.3 Borg scale units.

In conclusion, the use of tiotropium was associated with sustainedreductions of lung hyperinflation at rest and during exercise.Resultant increases in inspiratory capacity permitted greaterexpansion of tidal volume and contributed to improvements inboth exertional dyspnoea and exercise endurance.

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Eur. Respir. J., January 1, 2005; 25(1): 186 - 199.
[Abstract] [Full Text] [PDF]

N. J. Gross
Tiotropium Bromide
Chest, December 1, 2004; 126(6): 1946 - 1953.
[Abstract] [Full Text] [PDF]