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Adding in tiotropium cuts mortaility in COPD patients

By Adam Legge

The anticholinergic tiotropium significantly cuts mortality, admission rates and exacerbations in patients with COPD, a major new trial reports.

UPLIFT found significant benefits for the treatment compared with placebo plus usual care, but it did not find a significant impact on the primary outcome – a reduction in the rate of decline of lung function.

Data from the study of 5,993 patients was presented at this week's European Respiratory Society conference in Berlin and published simultaneously in the New England Journal of Medicine.

The four-year trial randomised patients to receive 18µg tiotropium once daily or placebo. All patients continued to receive their normally prescribed drugs, including long-acting ß-agonists and inhaled steroids.

Patients taking tiotropium had a significant delay in time to first exacerbation of just over four months – 16.7 versus 12.5.

It also reduced exacerbations by 14%, exacerbations leading to hospitalisation by 12% and risk of death by 16%.

UK lead investigator Dr David Halpin, consultant respiratory physician and senior clinical lecturer at the Royal Devon and Exeter Hospital, said: ‘What we're looking at is an additive effect of tiotropium.'

, which resulted in fewer exacerbations, a better heath status and a reduced risk of death.'

Dr Steve Holmes, a GP in Shepton Mallet, Somerset, and member of the General Practice Airways Group, said: ‘I think we're going to take away that it's important to treat earlier and that tiotropium reduces exacerbations, admissions and mortality.'

Last week UPLIFT data showing respiratory and cardiac morbidity was lower in the tiotropium group was released early - after a JAMA paper suggested anticholinergics increased the risk of cardiovascular events.

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