PURPOSE: Long-acting bronchodilators, such as tiotropium and salmeterol, are recommended as first-line treatments for patients with chronic obstructive pulmonary disease (COPD). However, the influence of these drugs on postoperative patients with COPD is not well known. In this study, a prospective randomized trial was designed to examine the efficacy of tiotropium and salmeterol on postoperative pulmonary function and quality of life (QOL) in lung cancer patients with COPD.
METHODS: Twenty lung cancer patients with preoperative FEV1/FVC less than 70% were enrolled and randomized. The control group (n=10) was lobectomy without any bronchodilators and the experimental group (n=10) was lobectomy with postoperative daily inhalation of tiotropium and salmeterol. Pulmonary function test, 6minutes walking test, and the St. George's Respiratory Questionnaire (SGRQ) were compared between the two groups at preoperative period, 2 weeks, 3 and 6 months postoperatively. Furthermore, patients were divided into two COPD grades, stage I COPD (FEV1≧80% predicted) and stage II to III COPD (FEV1<80% predicted), and the trends of the above parameters were analyzed.
RESULTS: Patient backgrounds were similar between the two groups. None of the parameters were statistically significant between the control and the experimental groups at any time points. However, in stage II to III COPD, FEV1, Vital capacity, Inspiratory capacity and the total score of SGRQ in the experimental group (n=5) were significantly better than those in the control group (n=4) at various time points (all p<.05). In stage I COPD, similar trends of the parameters were observed between the two groups and there were no statistical significances.
CONCLUSION: In moderate to severe COPD patients, postoperative daily inhalation of tiotropium and salmeterol was effective for maintaining respiratory function and the QOL after pulmonary resection for lung cancer.
CLINICAL IMPLICATIONS: Long-acting bronchodilators are now available for use in COPD, but there were no evidence of efficacy for surgical treatment. This study may provide benefits for lung cancer patients with COPD requiring surgical resection.
DISCLOSURE: Hidemi Suzuki, No Financial Disclosure Information; No Product/Research Disclosure Information