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Tiotropium as essential maintenance therapy in COPD

CORRESPONDENCE: M. Decramer, Respiratory Division, Katholieke Universiteit Leuven, University Hospital, Herestraat 49, 3000 Leuven, Belgium. Fax: 32 16346803. E-mail: Marc.Decramer{at}uz.kuleuven.ac.be

Over the past decade, several large-scale clinical trials have been performed to assess the impact of pharmacological treatments on patient-centred outcomes such as dyspnoea, exercise tolerance, exacerbations and health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD).

Tiotropium, a once-daily inhaled anticholinergic agent that works through prolonged muscarinic M₃ receptor blockade, has consistently been shown to provide sustained improvements in lung function parameters. Furthermore, several prospective trials have shown that tiotropium improves exercise tolerance and augments the beneficial effects of pulmonary rehabilitation. Beyond these important physiological outcomes, tiotropium has been shown to reduce dyspnoea, decrease the frequency of exacerbations and improve HRQoL in studies of 1 yr in duration. Such improvements in patient-centred outcomes may allow patients to increase their activity levels, thereby interrupting the downward spiral of chronic inactivity that leads to physical deconditioning and further reductions in exercise tolerance.

Recently, combination therapies of two long-acting bronchodilators have been examined more closely regarding their potential to provide patients with superior symptom relief compared with that provided by single-agent therapy.

Because maintenance treatment with tiotropium provides consistent and sustained improvements in many relevant clinical outcomes of chronic obstructive pulmonary disease, it may reduce the progression of the disease. This hypothesis is being tested in the ongoing Understanding the Potential Long-term Impacts on Function with Tiotropium (UPLIFT) trial.

KEYWORDS: Bronchodilators, chronic obstructive pulmonary disease, dyspnoea, exercise tolerance, quality of life, tiotropium