Tuberc Respir Dis.  2009 Dec;67(6):536-544.

Comparison for the Effects of Triple Therapy with Salmeterol/Fluticasone Propionate and Tiotropium Bromide versus Individual Components in Patients of Severe COPD Combined with Bronchial Hyperresponsiveness

• Sohn JY
• Kim SR
• Park SJ
• Lee HB
• Lee YC
• Rhee YK

Abstract

BACKGROUND
A combination of salmeterol and fluticasone propionate (SFC) and tiotropium bromide (TIO) is commonly prescribed for COPD patients but there is little data on their effectiveness, particularly in COPD patients with bronchial hyperresponsiveness. This study compared the spirometric improvement based on the change in FEV1, FEV1/FVC, and IC as well as the clinical outcomes of the therapeutic strategies with SFC and TIO versus the individual components in patients with severe COPD and bronchial hyperresponsiveness. METHODS: This study examined the spirometric data and clinical outcomes of 214 patients with COPD and hyperresponsiveness, who were divided into three groups according to the therapeutic regimen (TIO only, SFC only, and a triple therapy regimen). RESULTS: All regimen groups showed early improvement in the FEV1 and IC (at 3- and 6 months after treatment). However, long-term beneficial effects were observed only in the SFC group (at 24 months after treatment). However, these beneficial effects decreased after a 36-month follow up. In all spirometric results, the 12-, 24-, and 36-months data showed a similar degree of improvement in the three groups. The triple therapy group showed higher St. George's Respiratory Questionnaire scores and lower acute exacerbations and hospitalization. CONCLUSION: SFC can be a more important component in the pharmacological treatment of severe COPD patients with hyperresponsiveness than TIO, particularly in the spirometric and clinical outcomes.

Keyword

Pulmonary Disease, Chronic Obstructive; Drug Therapy, Combination; Treatment Outcome

MeSH Terms

Albuterol
Androstadienes
Diethylpropion
Drug Therapy, Combination
Follow-Up Studies
Hospitalization
Humans
Pulmonary Disease, Chronic Obstructive
Surveys and Questionnaires
Scopolamine Derivatives
Treatment Outcome
Fluticasone
Tiotropium Bromide
Salmeterol Xinafoate
Albuterol
Androstadienes
Diethylpropion
Scopolamine Derivatives

Figure

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  Figure 1 Effects of triple therapy with SFC plus TIO or individual components on ΔFEV1 (L). All regimen groups have shown the early improvement of FEV1 (at 3- and 6 months after treatment). Long-term beneficial effects have been observed in only SFC group (at 24 months after treatment). ΔFEV1 means the change of FEV1 compared with the value at pre-treatment. SFC: salmeterol/fluticasone propionate; TIO: tiotropium bromide. *p<0.05 vs. pre-treatment value.

• 

  Figure 2 Effects of triple therapy with SFC plus TIO or individual components on ΔIC (L). All regimen groups have shown the early improvement of IC (at 3- and 6 months after treatment). Long-term beneficial effects have been observed in only SFC group (at 24 months after treatment). ΔIC means the change of IC compared with the value at pre-treatment. SFC: salmeterol/fluticasone propionate; TIO: tiotropium bromide; IC: inspiratory capacity. *p<0.05 vs. pre-treatment value.

• 

  Figure 3 Effects of triple therapy with SFC plus TIO or individual components on ΔFEV1/FVC (%). The early improvement of FEV1/FVC has been noted in only triple therapy group (at 3-months after treatment). Long-term beneficial effects have been observed in only TIO group (at 24 months after treatment). ΔFEV1/FVC means the change of FEV1/FVC compared with the value at pretreatment. SFC: salmeterol/fluticasone propionate; TIO: tiotropium bromide. *p<0.05 vs. pre-treatment value.

• 

  Figure 4 St. George's Respiratory Questionnaire scores. Lower scores indicate improvements in quality of life. *p<0.05 vs.TIO group.

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