Combining triple therapy and pulmonary rehabilitation in patients with advanced COPD: A pilot study
Received 21 August 2009; accepted 6 October 2009. published online 05 November 2009. Corrected Proof
Summary
Background
The synergistic interactions between pharmacotherapy and pulmonary rehabilitation has been provided, but it remains to be established whether this may also apply to more severe patients.
Objectives
We have examined whether tiotropium enhances the effects of exercise training in patients with advanced COPD (FEV1≤60% predicted, hypoxemia at rest corrected with oxygen supplementation, and limitations of physical activity).
Methods
We enrolled 22 patients that were randomised to tiotropium 18μg or placebo inhalation capsules taken once daily. Both groups (11 patients in each group) underwent an in patient pulmonary rehabilitation program and were under regular treatment with salmeterol/fluticasone twice daily. Each rehabilitation session was held 5 days per week (3h/day) for a total of 4 weeks.
Results
Compared to placebo, tiotropium had larger impact on pulmonary function (FEV1+0.164L, FVC +0.112L, RV −0.544L after tiotropium, FEV1+0.084L, FVC −0.039L, RV −0.036L after placebo). The addition of tiotropium allowed a longer distance walked in 6min (82.3m vs. 67.7m after placebo) and reduced dyspnoea (Borg score) (−0.4 vs. +0.18 after placebo) when compared with baseline (pre pulmonary rehabilitation program). The changes in SGRQ from baseline to the end of treatment were: total score −28.3U, activity −27.8U, impact −14.5U, and symptoms −33.4U in the placebo group; and total score −19.1U, activity −18.9U, impact −16.4U, and symptoms −33.8U in the tiotropium group.
Conclusions
Our study clearly indicates that there is an advantage in combining pulmonary rehabilitation with an aggressive drug therapy in more severe patients.
aDivision of Pulmonary Rehabilitation, San Raffaele Hospital, Velletri (Rome), Italy
bDivision of Respiratory Medicine and Unit of Respiratory Clinical Pharmacology, Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
Corresponding author at: Dipartimento di Medicina Interna, Università di Roma Tor Vergata, Via Montpellier 1, 00133 Roma, Italy.
ABSTRACT
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