0
Original Research: COPD |

Effects of Tiotropium With and Without Formoterol on Airflow Obstruction and Resting Hyperinflation in Patients With COPD*

Jan A. van Noord, MD, PhD, FCCP; Joseph L. Aumann, MD; Eduard Janssens, MD; Jan Verhaert, MD; Joseph J. Smeets; Achim Mueller; Piet J. G. Cornelissen, PhD
Author and Funding Information

*From Atrium Medisch Centrum (Dr. van Noord and Mr. Smeets), Heerlen, the Netherlands; Virga Jesse Ziekenhuis (Dr. Aumann), Hasselt, Belgium; Ziekenhuis Oost-Limburg (Drs. Janssens and Verhaert), Lanaken, Belgium; and Boehringer Ingelheim bv (Mr. Mueller and Dr. Cornelissen), Alkmaar, the Netherlands.

Correspondence to: Jan A. van Noord, MD, PhD, FCCP, Department of Respiratory Diseases, Atrium medisch centrum, Henri Dunantstraat 5, 6419 PC Heerlen, the Netherlands; e-mail: j.a.vannoord@atriummc.nl



Chest. 2006;129(3):509-517. doi:10.1378/chest.129.3.509
Text Size: A A A
Published online

Background: The combination of short-acting β2-agonists and anticholinergics in the treatment of COPD has been well documented, but data on combination of long-acting agents are lacking.

Methods: A randomized, open-label, placebo-controlled, three-way crossover study was conducted comparing 2-week treatment periods of tiotropium alone to tiotropium plus formoterol once or twice daily following a 2-week pretreatment period with tiotropium. Lung function (FEV1, FVC, and resting inspiratory capacity [IC]) serially over 24 h was measured in 95 patients with stable COPD at baseline and after 2 weeks of each treatment.

Results: Mean baseline FEV1 was 1.05 L (38% of predicted). There was a circadian variation in FEV1, FVC, and IC at baseline that was maintained during all treatment periods. Average FEV1 (0 to 24 h) improved by 0.08 L with tiotropium, by 0.16 L with tiotropium plus formoterol once daily, and by 0.20 L with tiotropium plus formoterol twice daily (p < 0.01 for all comparisons). Compared with tiotropium alone, add-on formoterol in the morning produced improvement in FEV1, FVC, and IC for > 12 h. The second add-on dose of formoterol in the evening caused further improvement in FEV1 for 12 h, but in FVC and IC for < 12 h. Peak increase in FEV1 was 0.23 L (22% of baseline) with tiotropium and 0.39 L (37% of baseline) with tiotropium plus formoterol (p < 0.0001). Compared with tiotropium alone, add-on formoterol once and twice daily reduced the use of rescue salbutamol during the daytime (p < 0.01) and with add-on formoterol twice daily also during the nighttime (p < 0.05). The combination of tiotropium and formoterol was well tolerated.

Conclusion: In the treatment of COPD, there is benefit from adding formoterol once or twice daily to tiotropium once daily in terms of improvement in airflow obstruction, resting hyperinflation, and the use of rescue salbutamol.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543