Effect of tiotropium bromide on efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Abstract

Efficacy of combination of pulmonary rehabilitation (PR) and tiotropium bromide (TB) was studied in the open prospective randomized comparative trial in 87 patients with moderate and severe chronic obstructive pulmonary disease (COPD), the mean FEV₁ , 1.70 ± 0.43 L (49.1 ± 10.7 %_pred. ). Of them, 46 patients received TB (Spiriva) 18 μg daily plus 8-wk PR course (the PR+TB group) and 41 patients received the PR alone (the PR group). Physical tolerability was assessed using 6-minute walk distance (6-MWD), dyspnea was evaluated with the baseline (BDI) and transitional (TDI) dyspnea indices, quality of life (QoL) was assessed using St.George's Respiratory Questionnaire. We also assessed rate and length of exacerbations of COPD. The TB+PR group had FEV₁ higher compared with the PR group after the 92nd day of the study. The 6-MWD increased by 24.6 % (60.2 ± 9.5 m, р = 0.03) and by 19.8 % (50.4 ± 9.1 m), respectively, to the end of the study. In a year, the total dyspnea score was 0.75 ± 0.25 in the TB + PR group and 0.44 in the PR group (р < 0.05). The exacerbation rate reduced by 22.5 %, the number of exacerbations per one patient per a year decreased by 31.6 %, and the number of days of exacerbation per one patient per a year decreased by 25.3 % (p < 0.05) in the TB + PR group compared with the PR group. To the end of the study clinically significant improvement in QoL was found in 49 % of the TB + PR patients and in 27 % of the PR patients (р = 0.001). Therefore, the results have demonstrated the combinations of TB+PR to be superior to the PR alone in moderate and severe COPD patients that was as better lung function, higher physical tolerance, clinically significant improvement of dyspnea, less use of salbutamol as-needed, higher QoL, longer (up to 6 months) maintenance of the rehabilitation success.