RT Journal Article SR Electronic T1 Effectiveness of tiotropium in low-risk patients according to new GOLD severity grading JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP P2190 VO 40 IS Suppl 56 A1 David Halpin A1 Marc Decramer A1 Bart Celli A1 Antonio Martín A1 Inge Leimer A1 Norbert Metzdorf A1 Donald Tashkin YR 2012 UL http://erj.ersjournals.com/content/40/Suppl_56/P2190.abstract AB Background: GOLD recently updated their COPD severity classification to include risk of exacerbations. Increased risk is typically defined by a FEV1 of <50% pred and/or ≥2 exacerbations in the previous year (C+D) and low risk by a FEV1 ≥50% pred and 0-1 exacerbation in the previous year (A+B).Aims and objectives: To examine the effect of tiotropium 18 µg qd via Handihaler® in GOLD low risk patients (pts) using data from a 4-y, randomized, double-blind, placebo-controlled trial in COPD (UPLIFT®).Methods: Retrospective analysis of exacerbations, lung function and QoL (SGRQ) in low-risk pts (pts with a baseline postbronchodilator [BD] FEV1 %pred ≥50% and ≤1 oral steroid/antibiotic course in the previous year). Pts with high risk (FEV1 %pred <50% or more than 1 course of oral steroids/antibiotics) were also analyzed.Results: 2012 pts were analyzed (mean age 64.5±8.6 y, male 74%, mean (±SD) baseline postBD FEV1 1.65 (0.37) L and FEV1 %pred (±SD) 58.9 (5.8). The HR (tiotropium vs control) for time to first exacerbation was 0.76 (95% CI, 0.68; 0.86; P<0.0001); mean annual exacerbation rates were 0.43 (95% CI, 0.40; 0.48) vs 0.61 (0.56; 0.66), rate ratio 0.72 (0.63; 0.81; P<0.0001). The SGRQ total score after 4 y was significantly improved by tiotropium vs placebo: −3.63 (95% CI, −5.14; −2.12; P<0.0001) and the respective increase for trough FEV1 was 110 mL (95% CI, 84; 136; P<0.0001). SGRQ and trough FEV1 were significantly improved at all time points. The above-mentioned endpoints were also significantly improved in the high-risk population.Conclusion: Tiotropium qd was effective throughout 4 y in reducing exacerbations and improving lung function and QoL in low-risk pts with COPD (GOLD A+B).