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Original Research: COPD |

Effects of Short-Acting Bronchodilators Added to Maintenance Tiotropium Therapy*

Huib A. M. Kerstjens, MD, PhD; Theo A. Bantje, MD; Peter B. Luursema, MD; Henk E. J. Sinninghe Damste, MD; Jan W. de Jong, MD, PhD; Angela Lee, BSc, MSc, Cstat; Stella P. C. Wijker, MSc; Piet J. G. Cornelissen, PhD
Author and Funding Information

*From University Medical Center Groningen (Dr. Kerstjens), Groningen; Amphia Hospital (Dr. Bantje), Breda; Gelre Hospitals (Dr. Luursema), Zutphen; Hospital Group Twente (Dr. Sinninghe Damste), Almelo; Sint Lucas Hospital (Dr. de Jong), Winschoten; Boehringer Ingelheim bv (Ms. Lee, Ms. Wijker, and Dr. Cornelissen), Alkmaar, the Netherlands.

Correspondence to: Huib A. M. Kerstjens, MD, PhD, Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands; e-mail: h.a.m.kerstjens@int.umcg.nl



Chest. 2007;132(5):1493-1499. doi:10.1378/chest.06-3059
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Background: Combining bronchodilators has been shown to be beneficial in patients with COPD. The additive effects of short-acting bronchodilators added to maintenance tiotropium therapy, however, are unknown.

Methods: Following 3 weeks of tiotropium pretreatment, 60 patients with COPD (FEV1 40% of predicted) participated in a randomized, placebo-controlled study to assess add-on bronchodilator effects of ipratropium bromide (40 μg) or fenoterol (200 μg). Short-acting bronchodilators were added as a single dose 2 h and 8 h after tiotropium dosing. Serial lung function tests were performed over 9 h.

Results: The peak FEV1 add-on response within 6 h with fenoterol was significantly greater than with placebo (137 mL) or ipratropium (84 mL); the response with ipratropium was slightly but significantly larger than with placebo (52 mL). One hour after the second dose of the test drugs, a similar order of treatment responses was found. The peak FVC add-on response was significant for fenoterol (249 mL) but not for ipratropium (42 mL).

Conclusions: In conclusion, both short-acting bronchodilator classes were effective when added to maintenance treatment with tiotropium. The addition of the β2-adrenergic fenoterol provided greater additional bronchodilatation than the short-acting anticholinergic ipratropium. This is consistent with the expected effects of combining bronchodilators with different pharmacologic mechanisms. This randomized controlled trial was registered at www.clinicaltrials.gov (NCT00274066).

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