Release date: 2017-09-11
On September 7th, the New England Journal of Medicine published the Tiotropium in Early-Stage Chronic Obstructive Pulmonary Disease (Tiotropium in Early-Stage Chronic Obstructive Pulmonary Disease).
Neglected early chronic obstructive pulmonary disease clinical study
The COPD Global Initiative (GOLD) 2017 proposes that treatment goals for COPD include short-term goals (improving symptoms, activity endurance and quality of life) and long-term goals (delaying disease progression rates, reducing the frequency of acute exacerbations, and reducing mortality). Clinical trials of COPD drugs are less likely to focus on patients with a GOLD 1 grade or a CAT score <10, and even a few studies that focus on them are only post hoc analyses. Early chronic obstructive pulmonary disease has been neglected. The diagnosis and treatment of chronic obstructive pulmonary disease (KD) is a breakthrough in the prevention and control of chronic obstructive pulmonary disease.
Looking for breakthroughs in prevention and control of chronic obstructive pulmonary disease
The clinical efficacy and safety of tiotropium in the treatment of early chronic obstructive pulmonary disease was studied by the team of Professor Zhong Nanshan of the Guangzhou Institute of Respiratory Diseases published in the New England Journal of Medicine on September 7, 2017. This was a multicenter, randomized, double-blind, placebo-controlled trial in China involving 841 patients with GOLD grade 1 (mild) or GOLD grade 2 (moderate) chronic obstructive pulmonary disease.
A total of 388 patients in the tiotropium group and 383 patients in the placebo group were included in the full analysis set. During the study period, the FEV1 was significantly higher in the tiotropium group than in the placebo group. In contrast, after the use of bronchodilators, the annual decline in FEV1 in the tiotropium group was significantly lower than in the placebo group. At the same time, tiotropium can reduce the number of acute exacerbations and improve the quality of life in patients with COPD, which is consistent with other studies at home and abroad.
Tiotropium bromide alleviates lung function decline in early COPD
In the choice of individualized treatment options, patients with early COPD have a rapid rate of decline in lung function even without symptoms, so it is still necessary to pay attention to the severity of lung function airflow limitation during the treatment.
So far, there are no clear and effective drugs that can delay the rate of decline in lung function. For the cornerstone drug LAMA tiotropium bromide for chronic obstructive pulmonary disease, different clinical studies have found differences in the effect of tiotropium on the rate of decline in lung function due to differences in study design and sample size. Studies have reported that tiotropium can delay the decline in lung function in patients with GOLD grade 2 chronic obstructive pulmonary disease, but only 6 ml / year difference compared with placebo, no clinical significance.
The patients enrolled in this study were patients with COPD from community screening, with grade I accounting for 40%, and 70% of patients with CAT score <10. These patients rarely experience acute exacerbations and are less likely to be treated with medication. In 24 months of treatment, tiotropium compared to placebo in patients with GOLD grade 1 and GOLD grade 2 chronic obstructive pulmonary disease, increased FEV1 in patients, and decreased the rate of decline in FEV1 in patients after bronchodilator use.
At present, the early intervention of tiotropium can affect the long-term course of COPD and needs further study.
Source: Physician
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