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November 16, 2011

posted Nov 14, 2011, 7:23 AM by David de Gijsel   [ updated Nov 16, 2011, 3:48 PM ]

     Nihal was inspired to present this article about COPD to increase his knowledge of COPD management. This is an industry sponsored and orchestrated trial and the three authors that were actively employed by the makers of Spiriva helped in writing the manuscript and had editing rights to the final manuscript. This trial took place at 725 centers and 900 different sites mainly throughout Europe. They recruited patients with moderate to severe COPD, excluding anyone with other "significant comorbidities", hx of asthma, unstable DM, recent MI, CHF with recent exacerbation among other criteria. They then performed a double blind, double dummy analysis of Tiatroprium vs Salmeterol MDI. Patients could continue fluticasone or prednisone if using these medications prior to the study. 
     Tiatroprium was found to significantly delay the first occurrence of COPD exacerbation (the primary outcome) by 42 days compared with Salmeterol, with a hazard ratio of around 0.7. The number of overall exacerbations reported were also significantly decreased in the Spiriva group (a secondary outcome). There was no significant difference in side effects.  
Our take home point was that Spiriva in this group did delay the initial exacerbation as compared to Salmeterol over one year. Although it is difficult to apply this to all our patients given the broad exclusion criteria and the nagging feeling that there might be an inherent difference in this patient population of European smokers with COPD and our patients in the Bronx with COPD.