Elsevier

Respiratory Medicine

Volume 106, Issue 10, October 2012, Pages 1413-1420
Respiratory Medicine

Effect of combination treatment on lung volumes and exercise endurance time in COPD

https://doi.org/10.1016/j.rmed.2012.05.011Get rights and content
Under an Elsevier user license
open archive

Summary

Background

Data comparing two bronchodilators vs. one bronchodilator plus inhaled corticosteroid (ICS) on hyperinflation and exercise endurance in chronic obstructive pulmonary disease (COPD) are scarce, though these therapeutic strategies are widely used in clinical practice.

Methods

We performed a randomized, crossover clinical trial of two × 8 weeks comparing tiotropium (18 μg once daily) + salmeterol (50 μg twice daily) (T + S) to salmeterol + fluticasone (50/500 μg twice daily) (S + F) in COPD (forced expiratory volume in 1 s (FEV1) ≤65% predicted, and thoracic gas volume (TGV) ≥120% predicted). Coprimary endpoints were postbronchodilator TGV and exercise endurance time (EET).

Results

In 309 patients, at baseline, prebronchodilator FEV1 was 1.36 L (46% predicted), TGV was 5.42 L (165% predicted), and EET = 458 s. Relative to S + F, T + S lowered postdose TGV by 182 ± 44 ml after 4 weeks (p < 0.0001) and 87 ± 44 ml after 8 weeks (p < 0.05). EET was nonsignificantly increased following T + S treatment (20 ± 15 s at 4 weeks, 15 ± 13 s at 8 weeks) vs. S + F. BORG dyspnea score at exercise isotime was reduced in favor of T + S.

Conclusion

The two bronchodilators decreased hyperinflation significantly more than one bronchodilator and ICS. This difference was not reflected in EET.

(ClinicalTrials.gov number, NCT00530842)

Keywords

Tiotropium
Salmeterol
Fluticasone
Chronic obstructive pulmonary disease
Lung hyperinflation
Exercise endurance

Cited by (0)