Journal ArticleDOI
Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease: a randomized trial.
Shawn D. Aaron,Katherine L. Vandemheen,Dean Fergusson,François Maltais,Jean Bourbeau,Roger S. Goldstein,Meyer Balter,Denis E. O'Donnell,Andrew McIvor,Sat Sharma,Graham Bishop,John Anthony,Robert L. Cowie,Stephen K. Field,Andrew Hirsch,Paul Hernandez,R. N. Rivington,Jeremy Road,Victor Hoffstein,Richard V. Hodder,Darcy D Marciniuk,David G. McCormack,George A Fox,Gerard Cox,Henry B. Prins,Gordon T. Ford,Dominique Bleskie,Steve Doucette,Irvin Mayers,Kenneth R. Chapman,Noe Zamel,Mark FitzGerald +31 more
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A randomized, double-blind, placebo-controlled clinical trial to determine whether combining tiotropium with salmeterol or fluticasonesalmeterol produces greater improvements in clinical outcomes for adults with moderate or severe COPD compared with tiotopium therapy alone.Abstract:
Background Treatment of moderate or severe chronic obstructive pulmonary disease (COPD) with combinations of inhaled corticosteroids, long-acting beta-agonists, and long-acting anticholinergic bronchodilators is common but unstudied. Objective To determine whether combining tiotropium with salmeterol or fluticasone-salmeterol improves clinical outcomes in adults with moderate to severe COPD compared with tiotropium alone. Design Randomized, double-blind, placebo-controlled trial conducted from October 2003 to January 2006. Setting 27 academic and community medical centers in Canada. Patients 449 patients with moderate or severe COPD. Intervention 1 year of treatment with tiotropium plus placebo, tiotropium plus salmeterol, or tiotropium plus fluticasone-salmeterol. Measurements The primary end point was the proportion of patients who experienced an exacerbation of COPD that required treatment with systemic steroids or antibiotics. Results The proportion of patients in the tiotropium plus placebo group who experienced an exacerbation (62.8%) did not differ from that in the tiotropium plus salmeterol group (64.8%; difference, -2.0 percentage points [95% CI, -12.8 to 8.8 percentage points]) or in the tiotropium plus fluticasone-salmeterol group (60.0%; difference, 2.8 percentage points [CI, -8.2 to 13.8 percentage points]). In sensitivity analyses, the point estimates and 95% confidence bounds shifted in the direction favoring tiotropium plus salmeterol and tiotropium plus fluticasone-salmeterol. Tiotropium plus fluticasone-salmeterol improved lung function (P = 0.049) and disease-specific quality of life (P = 0.01) and reduced the number of hospitalizations for COPD exacerbation (incidence rate ratio, 0.53 [CI, 0.33 to 0.86]) and all-cause hospitalizations (incidence rate ratio, 0.67 [CI, 0.45 to 0.99]) compared with tiotropium plus placebo. In contrast, tiotropium plus salmeterol did not statistically improve lung function or hospitalization rates compared with tiotropium plus placebo. Limitations More than 40% of patients who received tiotropium plus placebo and tiotropium plus salmeterol discontinued therapy prematurely, and many crossed over to treatment with open-label inhaled steroids or long-acting beta-agonists. Conclusions Addition of fluticasone-salmeterol to tiotropium therapy did not statistically influence rates of COPD exacerbation but did improve lung function, quality of life, and hospitalization rates in patients with moderate to severe COPD. International Standard Randomised Controlled Trial registration number: ISRCTN29870041.read more
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Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.
Jørgen Vestbo,Suzanne S. Hurd,Alvar Agusti,Paul W. Jones,Claus Vogelmeier,Antonio Anzueto,Peter J. Barnes,Leonardo M. Fabbri,Fernando J. Martinez,Masaharu Nishimura,Robert A. Stockley,Don D. Sin,Roberto Rodriguez-Roisin +12 more
TL;DR: It is recommended that spirometry is required for the clinical diagnosis of COPD to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation.
Journal ArticleDOI
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary
Claus Vogelmeier,Gerard J. Criner,Fernando J. Martinez,Antonio Anzueto,Peter J. Barnes,Jean Bourbeau,Bartolome R. Celli,Rongchang Chen,Marc Decramer,Leonardo M. Fabbri,Peter Frith,David M.G. Halpin,M. Victorina López Varela,Masaharu Nishimura,Nicolas Roche,Roberto Rodriguez-Roisin,Don D. Sin,Dave Singh,Robert Stockley,Jørgen Vestbo,Jadwiga A. Wedzicha,Alvar Agusti +21 more
TL;DR: The assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation, and the concept of deescalation of therapy is introduced in the treatment assessment scheme.
Journal ArticleDOI
Azithromycin for Prevention of Exacerbations of COPD
Richard K. Albert,Richard K. Albert,John E. Connett,William C. Bailey,Richard Casaburi,J. Allen D. Cooper,Gerard J. Criner,Jeffrey L. Curtis,Mark T. Dransfield,MeiLan K. Han,Stephen C. Lazarus,Barry J. Make,Nathaniel Marchetti,Fernando J. Martinez,Nancy E. Madinger,Charlene McEvoy,Dennis E. Niewoehner,Janos Porsasz,Connie S. Price,Connie S. Price,John J. Reilly,Paul D. Scanlon,Frank C. Sciurba,Steven M. Scharf,George R. Washko,Prescott G. Woodruff,Nicholas R. Anthonisen +26 more
TL;DR: Among selected subjects with COPD, azithromycin taken daily for 1 year, when added to usual treatment, decreased the frequency of exacerbations and improved quality of life but caused hearing decrements in a small percentage of subjects.
Journal ArticleDOI
Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society
Amir Qaseem,Timothy J Wilt,Steven E. Weinberger,Nicola A. Hanania,Gerard J. Criner,Thys van der Molen,Darcy D. Marciniuk,Tom Denberg,Holger J. Schünemann,Wisia Wedzicha,Roderick MacDonald,Paul G. Shekelle +11 more
TL;DR: The value of history and physical examination for predicting airflow obstruction; the value of spirometry for screening or diagnosis of COPD; and COPD management strategies, specifically evaluation of various inhaled therapies, pulmonary rehabilitation programs, and supplemental oxygen therapy are addressed.
Journal ArticleDOI
COPD exacerbations: defining their cause and prevention.
TL;DR: The future of exacerbation prevention is in assessment of optimum combinations of pharmacological and non-pharmacological therapies that will result in improvement of health status, and reduction of hospital admission and mortality associated with COPD.
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