eMedicineLive

The beneficial effects of tiotropium, a long acting antimuscarinic agent (LAMA) in COPD patients has been previously shown in a large trial (UPLIFT trial). UPLIFT, an acronym for ‘Understanding Potential Long Term Impacts on Function with Tiotropium’ established tiotropium as one of the primary drugs in the management of COPD patients.

A recent retrospective study with a mean follow up period of 4.65 years from the University of Dundee also attests to the usefulness of tiotropium. Investigators analyzed the outcomes of COPD patients on triple therapy (LABA + ICS +Tiotropium) versus those on double therapy (LABA + ICS).  It was found COPD patients treated with the triple therapy showed decreased mortality, reduced COPD exacerbations and hospital admissions. Adding tiotropium decreased the need for short bursts of parenteral steroid use during exacerbations but failed to show any improvement in the lung function parameters like FVC and FEV1.

Though the study was retrospective in nature with its inherent limitations with less than 3000 subjects, it is one of the real life studies confirming the effectiveness of tiotropium in COPD patients. The authors postulate that tiotropium by acting through a different mechanism confers further bronchodilation over that provided beta agonist.  Furthermore it is hypothesized that tiotropium might prevent beta2 receptor downregulation, thereby maintaining the efficacy of beta agonist agents.

ICS – Inhaled Corticosteroids
LABA – Long acting beta agonists
LAMA – Long acting anti muscarinic agents

References
http://www.ncbi.nlm.nih.gov/pubmed/21799028