Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease with Tiotropium
Authors: Dennis E. Niewoehner, Kathryn Rice, Stephen Kesten
Journal: Annals of Internal Medicine (2006)

Letters17 January 2006Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease with TiotropiumDennis E. Niewoehner, MD, Kathryn Rice, MD, and Stephen Kesten, MDDennis E. Niewoehner, MDFrom Veterans Affairs Medical Center, Minneapolis, MN 55417, and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT 06877.Search for more papers by this author, Kathryn Rice, MDFrom Veterans Affairs Medical Center, Minneapolis, MN 55417, and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT 06877.Search for more papers by this author, and Stephen Kesten, MDFrom Veterans Affairs Medical Center, Minneapolis, MN 55417, and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT 06877.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-144-2-200601170-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:The authors of both letters express concerns related to the discontinuation of ipratropium therapy in many participants. They view ipratropium as a standard of care in the community and therefore conclude that withdrawing the drug makes the trial both clinically irrelevant and unethical. We will briefly review the scientific basis for their claims.Two large trials compared the bronchodilator effects of ipratropium, albuterol, and both drugs used in combination (1, 2). Both trials clearly demonstrated that ipratropium is an effective bronchodilator in COPD, but albuterol produces almost identical responses. Combined treatment produces better bronchodilation than either drug alone, ...References1. COMBIVENT Inhalation Aerosol Study Group. In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone. An 85-day multicenter trial. Chest. 1994;105:1411-9. [PMID: 8181328] CrossrefMedlineGoogle Scholar2. COMBIVENT Inhalation Solution Study Group. Routine nebulized ipratropium and albuterol together are better than either alone in COPD. Chest. 1997;112:1514-21. [PMID: 9404747] CrossrefMedlineGoogle Scholar3. National Heart, Lung and Blood Institute. Global Initiative for Chronic Obstructive Lung Disease: Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (NHLBI/WHO workshop report). Bethesda, MD: National Heart, Lung and Blood Institute; 2001. Google Scholar4. O'Donnell DE, Aaron S, Bourbeau J, Hernandez P, Marciniuk D, Balter M, et al. State of the Art Compendium: Canadian Thoracic Society recommendations for the management of chronic obstructive pulmonary disease. Can Respir J. 2004;11 Suppl B 7B-59B. [PMID: 15340581] CrossrefMedlineGoogle Scholar5. Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA. 1994;272:1497-505. [PMID: 7966841] CrossrefMedlineGoogle Scholar6. Sin DD, McAlister FA, Man SF, Anthonisen NR. Contemporary management of chronic obstructive pulmonary disease: scientific review. JAMA. 2003;290:2301-12. [PMID: 14600189] CrossrefMedlineGoogle Scholar7. Wilt TJ, Niewoehner D, Kim C, Kane RL, Linabery A, Tacklind J, et al. Use of Spirometry for Case Finding, Diagnosis, and Management of Chronic Obstructive Pulmonary Disease (COPD). Evidence Report/Technology Assessment No. 121 AHRQ Publication No. 05-E017-2. Rockville, MD: Agency for Healthcare Research and Quality; 2005. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Veterans Affairs Medical Center, Minneapolis, MN 55417, and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT 06877.Disclosures: Employment: S. Kesten (Boehringer Ingelheim Pharmaceuticals); Consultancies: D.E. Niewoehner (Boehringer Ingelheim Pharmaceuticals); Honoraria: D.E. Niewoehner (Boehringer Ingelheim Pharmaceuticals), K. Rice (Boehringer Ingelheim Pharmaceuticals). PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPrevention of Exacerbations of Chronic Obstructive Pulmonary Disease with Tiotropium, a Once-Daily Inhaled Anticholinergic Bronchodilator Dennis E. Niewoehner , Kathryn Rice , Claudia Cote , Daniel Paulson , J. Allen D. Cooper Jr. , Larry Korducki , Cara Cassino , and Steven Kesten Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease with Tiotropium Chester B. Good and Lisa Longo Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease with Tiotropium Alec B. O'Connor Metrics 17 January 2006Volume 144, Issue 2Page: 148-149KeywordsAntibioticsBronchodilatorsConflicts of interestDrugsHealth careHospitalizationsLungsSafety ePublished: 17 January 2006 Issue Published: 17 January 2006 CopyrightCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...