Improvement in self-reported exercise participation with the combination of tiotropium and rehabilitative exercise training in COPD patients

Steven Kesten, Richard Casaburi, David Kukafka, Christopher B Cooper, Steven Kesten, Richard Casaburi, David Kukafka, Christopher B Cooper

Abstract

Background: Improvements in ventilatory mechanics with tiotropium increases exercise tolerance during pulmonary rehabilitation. We wondered whether tiotropium also increased physical activities outside of pulmonary rehabilitation.

Methods: COPD patients participating in 8 weeks of pulmonary rehabilitation were studied in a randomized, double-blind, placebo-controlled trial of tiotropium 18 microg daily (tiotropium = 47, placebo = 44). Study drug was administered for 5 weeks prior to, 8 weeks during, and 12 weeks following pulmonary rehabilitation. Patients completed a questionnaire documenting participation in pre-defined activities outside ofpulmonary rehabilitation during the 2 weeks prior to each visit. Patients who submitted an activity questionnaire at week 4 and on at least one subsequent visit were included in the analysis. For each patient, the number of sessions was multiplied with the duration of each activity and then summed to give overall activity duration.

Results: Patients (n = 46) had mean age of 67 years, mean baseline FEVJ of 0.84 L (33% predicted). Mean (SE) increase in duration of activities (minutes during 2 weeks prior to each visit) from week 4 (prior to PR) to week 13 (end of PR) was 145 (84) minutes with tiotropium and 66 (96) minutes with placebo. The increase from week 4 to week 25 (end of follow-up) was 262 (96) and 60 (93) minutes for the respective groups. Increases in activity duration from week 4 to weeks 17, 21, and 25 were statistically significant with tiotropium. No statistical differences over time were observed within the placebo-treated group and differences between groups were not significant.

Conclusions: Tiotropium appears to amplify the effectiveness of pulmonary rehabilitation as seen by increases in patient self-reported participation in physical activities.

Figures

Figure 1
Figure 1
Study design of 25-week randomized, controlled trial of tiotropium in COPD patients receiving pulmonary rehabilitation. Abbreviations: CWR, constant work exercise; PR, pulmonary rehabilitation; AQ, activity questionnaire. Notes: *Spirometry, Baseline/Transitional dyspnea index, and St. George’s respiratory questionnaire also performed.
Figure 2
Figure 2
Contents of activity questionnaire administered to COPD patients participating in the trial.
Figure 3
Figure 3
Mean (SE) minutes of activity during 2 weeks prior to each visit as reported through the activity questionnaire. Although not significantly different by statistical analysis, patients receiving tiotropium reported approximately 216 minutes more physical activity as compared with patients receiving placebo at week 25. Abbreviation: PR, pulmonary rehabilitation.
Figure 4
Figure 4
Mean (SE) difference in duration of activities from week 4 (prior to pulmonary rehabilitation) to subsequent visits as reported through the activity questionnaire. Patients receiving tiotropium reported on average 262 minutes more exercise at the end of the study whereas patients receiving placebo reported a gain of only 60 minutes.
Figure 5
Figure 5
Mean (SE) endurance times resulting from the combination of tiotropium and pulmonary rehabilitation in the subgroup of patients who completed the activity questionnaire. Patients receiving tiotropium continued to increase their measured exercise endurance during the 12-week period following pulmonary rehabilitation.

References

    1. Aalbers R, Ayres J, Backer V, et al. Formoterol in patients with chronic obstructive pulmonary disease: a randomized, controlled, 3-month trial. Eur Respir J. 2002;19:936–43.
    1. ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. ACCP/AACVPR Pulmonary Rehabilitation Guidelines. Chest. 1997;112:1363–96.
    1. Casaburi R, Kukafka D, Cooper CB, et al. Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest. 2005;127:809–17.
    1. Casaburi R, Mahler DA, Jones PW, et al. A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease. Eur Respir J. 2002;19:217–24..
    1. Celli BR, MacNee W ATS/ERS Task Force Committee Members. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932–46.
    1. Celli B, ZuWallack R, Wang S, et al. Improvements in resting inspiratory capacity and hyperinflation with tiotropium in COPD with increased static lung volumes. Chest. 2003;124:1743–8.
    1. [GOLD] Global Initiative for Chronic Obstructive Lung Disease. NHLBI/WHO Workshop Report [online] 2005. 2001, Update 2005. Accessed November 10, 2005. URL:
    1. Guyatt GH, Berman LB, Townsend M, et al. A measure of quality of life for clinical trials in chronic lung disease. Thorax. 1987;42:773–8.
    1. Jones PW, Quirk FH, Baveystock CM, et al. A self-complete measure of health status for chronic airflow limitation. Am Rev Respir Dis. 1992;145:1321–7.
    1. Mahler DA, Weinberg DH, Wells CK, et al. Baseline dyspnoea index and transitional dyspnoea index: The measurement of dyspnoea. Chest. 1984;85:751–8.
    1. Maltais F, Hamilton A, Marciniuk D, et al. Improvements in symptom-limited exercise performance over eight hours with once-daily tiotropium in patients with COPD. Chest. 2005;128:1168–78.
    1. Morris JF, Koski A, Temple WP, et al. Fifteen year interval spirometric evaluation of the Oregon predictive equations. Chest. 1988;93:123–7.
    1. O’Donnell D, Flüge T, Gerken F, et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J. 2004a;23:832–40.
    1. O’Donnell DE, Voduc N, Fitzpatrick M, et al. Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease. Eur Respir J. 2004b;24:86–94.
    1. Rennard SI, Anderson W, Zuwallack R, et al. Use of a long-acting inhaled β2-adrenergic agonist, salmeterol xinafoate, in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163:1087–92.
    1. Weaver TE, Narsavage GL. Physiological and psychological variables related to functional status in chronic obstructive pulmonary disease. Nurs Res. 1992;41:286–91.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir