Tiotropium - corticosteroid combination improves lung disease survival

Sufferers of chronic obstructive pulmonary disease have a greater chance of survival when treated with a combination of drugs that includes tiotropium, according to research at the University of Illinois at Chicago.

Chronic obstructive pulmonary disease makes breathing hard and worsens over time. COPD can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness and other symptoms. Smoking is the primary cause of the disease, according to the National Institutes of Health.

More than 12 million people are currently diagnosed with COPD, and an additional 12 million likely have the disease and don't know it, according to NIH. It is the fourth-leading cause of death in the United States and a major cause of disability. There is no cure, but treatments and lifestyle changes can help COPD sufferers feel better, stay more active, and slow the progress of the disease. Treatments include medicines, vaccines, pulmonary rehabilitation, oxygen therapy and surgery.

In the new study, Todd Lee, associate professor of pharmacy practice, and his research team compared more than 42,000 cases of COPD patients in the Veterans Health Administration two and a half years prior to tiotropium's 2004 entry into the marketplace and two and a half years after.

The study concluded that patients who were treated with tiotropium plus an inhaled corticosteroid and a long-acting beta-agonist lived longer and had fewer COPD-related hospital stays.

Tiotropium is an inhaled powder that opens up the airways in the lungs. Inhaled corticosteroids reduce inflammation in the lungs, while beta-agonists cause the airways to open more fully.

Most studies on tiotropium have been clinical trials. Those studies showed that the drug improves lung function, symptoms and quality of life, Lee said. But while evidence on the efficacy of the drug accumulates through prospective trials, Lee said it is important to examine outcomes in look-back studies because the patient populations may be vastly different.

Patients in Lee's study were at least 45 years old and diagnosed with COPD over a 12-month period. They must have received COPD medications from the VA and switched to a regimen that included tiotropium or inhaled corticosteroids plus long-acting beta-agonists.

Deaths were reduced by 40 percent in patients using the regimen of tiotropium plus inhaled corticosteroids plus long-acting beta-agonists compared to those treated with inhaled corticosteroids plus long-acting beta-agonists without tiotropium, Lee said.

The study is published in the August 2009 issue of Archives of Internal Medicine. It was funded by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

Co-authors on the paper are Caitlyn Wilke, pharmacy practice fellow at UIC; Dr. Min Joo, clinical instructor of pulmonary, critical care and sleep medicine at UIC; Kevin Stroupe, research associate professor at Northwestern University Feinberg School of Medicine; Dr. Jerry Krishnan, associate professor of medicine and health studies at the University of Chicago Medical Center; Glen Schumock, associate professor and director of the Center for Pharmacoeconomic Research at UIC; and Simon Pickard, associate professor of pharmacy practice at UIC.