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Eur Respir J 2007, doi:10.1183/09031936.00023907
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ORIGINAL ARTICLE |
Effect of tiotropium on sputum and serum inflammatory markers and exacerbations in chronic obstructive pulmonary disease
1 Southend University Hospital, Essex, UK
2 Academic Unit of Respiratory Medicine, Royal Free and University College Medical School, London, UK
3 Boehringer-Ingelheim, Bracknell, UK
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Abstract |
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COPD patients experiencing frequent exacerbations demonstrate increased stable state airway inflammation. Tiotropium has been shown to reduce exacerbation frequency but its effect on airway inflammation is unknown. We studied the effect of tiotropium on sputum inflammatory markers and exacerbation frequency.
142 patients were randomized to receive tiotropium or placebo in addition to their usual medication for one year. Sputum and serum cytokines were assayed by ELISA and exacerbation frequency calculated using a symptom based diary.
There was no difference in area under the curve for sputum IL-6 (p=0.324) or MPO (p=0.079) between the groups but sputum IL-8 was increased in the tiotropium arm (p=0.043). There was no difference between start and study end in serum IL-6 (p=0.691) or CRP (p=0.700).
Tiotropium was associated with a 52% reduction in exacerbation frequency (1.17 v 2.46 per year, p<0.01). 43% of patients on tiotropium experienced at least one exacerbation compared to 64% on placebo (p=0.01). Total exacerbation days were reduced compared to placebo (17.3 v 34.5, p<0.01).
Tiotropium reduces exacerbation frequency in COPD but this effect does not appear to be due to a reduction in airway or systemic inflammation.
Keywords: Anticholinergic, cytokines, sputum
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