PT  - JOURNAL ARTICLE
AU  - T. Troosters
AU  - B. Celli
AU  - T. Lystig
AU  - S. Kesten
AU  - S. Mehra
AU  - D.P. Tashkin
AU  - M. Decramer
TI  - Tiotropium as a first maintenance drug in COPD: secondary analysis of the UPLIFT® trial
AID  - 10.1183/09031936.00127809
DP  - 2010 Jul 01
TA  - European Respiratory Journal
PG  - 65--73
VI  - 36
IP  - 1
4099  - http://erj.ersjournals.com/content/36/1/65.short
4100  - http://erj.ersjournals.com/content/36/1/65.full
SO  - Eur Respir J2010 Jul 01; 36
AB  - The aim of the present study was investigate the long-term effect of tiotropium as first maintenance respiratory medication in chronic obstructive pulmonary disease (COPD). A 4-yr, randomised, multicentre, double-blind, parallel-group, placebo-controlled trial (Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT®)) was conducted. Analysis focused on the effect of tiotropium versus matching placebo in the 810 (13.5%) COPD patients not on other maintenance treatment (long-acting β-agonists, inhaled corticosteroids, theophyllines or anticholinergics) at randomisation. Spirometry, health-related quality of life (St George’s Respiratory Questionnaire (SGRQ) score), exacerbations of COPD and mortality were also analysed. 403 patients (mean±sd age 63±8 yrs, post-bronchodilator forced expiratory volume in 1 s (FEV1) 53±12% predicted) received tiotropium and 407 (64±8 yrs of age, post-bronchodilator FEV1 51±12% pred) received placebo. Post-bronchodilator FEV1 decline was 42±4 mL·yr−1 in the tiotropium group and 53±4 mL·yr−1 in the placebo group (p = 0.026). At 48 months, the morning pre-dose FEV1 was 134 mL higher in the tiotropium group compared to the placebo group (p<0.001). SGRQ total score declined more slowly in the tiotropium group (difference of 1.05±0.34 units·yr−1; p = 0.002). This was particularly significant for the impact (difference of 1.08±0.37 units·yr−1; p = 0.004) and activity (1.44±0.40 units·yr−1; p<0.001) domains, but not for symptoms (0.26±0.50 units·yr−1; p = 0.6). At 48 months, the difference in total score was 4.6 units (p<0.001) with tiotropium compared to placebo. In patients with COPD who are not on maintenance therapy, tiotropium is associated with significant benefits in disease progression.