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Interim Results of UPLIFT Trial Show Improvement in Lung Function With Combined Anticholinergic, Beta-Adrenergic Treatment: Presented at ERS

By Paula Moyer

COPENHAGEN, DENMARK -- September 28, 2005 -- Patients with chronic obstructive pulmonary disease (COPD) have a marked response in pulmonary function when given a combination of an anticholinergic and a beta-adrenergic agent.

A multinational team of investigators presented their findings on September 21^st here at the European Respiratory Society 15^th Annual Congress (ERS), which met September 17^th to the 21^st.

The Understanding the Potential Long-term Impacts on Function with Tiotropium (UPLIFT) study was designed to gauge lung function over time and to see whether tiotropium (Spiriva) would reduce hospitalization rates and slow decline in lung function.

An interim analysis of the study's data shows some promising findings regarding the most effective ways to improve pulmonary function on an acute basis in patients with COPD, according to principal investigator Bartolome Celli, MD, professor of medicine, Tufts University, and chief of pulmonary and critical care medicine, St. Elizabeth's Medical Center, Boston, Massachusetts.

"Most COPD patients achieved clinically meaningful increases in lung function following a combination of inhaled anticholinergics and sympathomimetics," Dr. Celli said. Sympathomimetics is another term used for beta-adrenergic medications such as albuterol.

"To assess maximal bronchodilator responsiveness, combination bronchodilators timed to achieve peak effects of each separate agent should be considered," he added.

Dr. Celli and colleagues evaluated the response to bronchodilators because the degree of reversibility expected with these agents is not clear, due to variations in the reported use of inhaled medication as well as the spirometry techniques that are used. Therefore, the team assessed acute bronchodilator response among the 5993 patients enrolled in UPLIFT.

After a 48-hour washout of bronchodilators, patients received 80 mcg of ipratropium and 400 mcg of albuterol 60 minutes later in order to maximize the peak effect of each agent. Patients underwent spirometry before and 90 minutes after being treated with ipratropium.

Patients were an average of 65 years old; 75% were men and 25% were women. At baseline, the average forced expiratory volume in 1 second (FEV₁) was 1.10 L, or 39% of predicted values for the subjects' age and height.

Interim results show that the average postbronchodilator FEV₁ was 23.6% over the predose FEV₁, or an average increase 1.10 L to 1.32 L. Approximately 65% of patients had an FEV₁ increase of at least 15%.

Forced vital capacity (FVC) increased from a pretreatment average of 2.62 L to an average of 3.09 L after bronchodilator treatment.

The findings show that staging the bronchodilator treatments is an effective way to achieve bronchodilation in COPD patients, Dr. Celli concluded.

The study is being funded by Boehringer Ingelheim, which manufactures Spiriva.


[Presentation title: Acute Bronchodilator Responsiveness in a Global Respiratory Trial (UPLIFT) Following Maximal Inhaled Bronchodilators. Abstract 4569]

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