Abstract
Background: Triple inhalation therapy with tiotropium (Tio) and salmeterol/fluticasone propionate (SFC) is widely used in the treatment of chronic obstructive pulmonary disease (COPD). However, the effects of triple therapy on airway structural changes remain unknown.
Aim: To compare the effects of Tio, salmeterol (SM), SFC, and Tio plus SFC on airway dimensions in COPD.
Methods: Patients with COPD were randomized to receive 16-week treatment periods in one of four-way study: (1) Tio (18 μg once daily; n=15), (2) SM (50 μg twice daily; n=14), (3) SFC (50/250 μg twice daily; n=16), (4) Tio plus SFC (n=15). Airway dimensions were assessed by a validated CT technique, and airway wall area corrected for body surface area (WA/BSA), percentage wall area (WA%), wall thickness (T)/√BSA, and luminal area (Ai)/BSA at the right apical segmental bronchus were measured. Pulmonary function and the St. George’s Respiratory Questionnaire (SGRQ) were evaluated.
Results: Tio plus SFC resulted in a significant decrease in WA/BSA, WA%, and T/√BSA compared with Tio, SM, and SFC (p<0.05, respectively). SFC significantly decreased WA% and T/√BSA (p<0.05), but these changes failed to reach statistical significant difference between Tio and SM. In the Tio plus SFC group, the changes in WA% and Ai/BSA were significantly correlated with changes in FEV1 (r=0.86, p<0.001, and r=048, p<0.05). There were more significant improvements in SGRQ scores after treatment with triple therapy than other treatments.Conclusions: The superiority of triple inhalation therapy may reflect improvements of the range of airway dimensions and pulmonary function measurements in COPD.
- © 2013 ERS