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Impacting patient-centred outcomes in COPD: exacerbations and hospitalisations

CORRESPONDENCE: R. Rodríguez-Roisin, Servei de Pneumologia, Hospital Clinic, Villarroel 170, Barcelona 08036, Spain. Fax: 34 932275455. E-mail: rororo{at}clinic.ub.es

Patients with chronic obstructive pulmonary disease (COPD) frequently develop exacerbations, leading to major clinical and healthcare utilisation ramifications. Exacerbations, especially those that result in hospitalisation, are the main cost driver in COPD and frequent exacerbations are associated with increased mortality, impaired health-related quality of life (HRQoL) and perhaps a more rapid decline in lung function over time. Prevention and treatment of exacerbations is, therefore, an important goal of maintenance therapy in COPD.

The impact of tiotropium, a long-acting anticholinergic agent, on exacerbations and associated healthcare utilisation has been studied in five randomised, controlled clinical trials of 6 months' duration involving >5,000 patients.

Analyses of adverse events reports submitted during three long-term efficacy and safety trials showed that tiotropium significantly reduced the incidence of exacerbations and delayed the time to first exacerbation, compared with either placebo or the short-acting anticholinergic agent, ipratropium. More recent prospective data confirmed previous findings.

Collectively, the results of these studies support the role of tiotropium as maintenance therapy in chronic obstructive pulmonary disease, demonstrating that this agent can provide significant reductions in the incidence of exacerbations and associated healthcare utilisation.

KEYWORDS: Bronchodilators, chronic obstructive pulmonary disease, exacerbations, healthcare utilisation, hospitalisation, long-acting anticholinergic agents