Chest
Original ResearchCOPDThe Impact of Tiotropium on Mortality and Exacerbations When Added to Inhaled Corticosteroids and Long-Acting β-Agonist Therapy in COPD
Section snippets
Materials and Methods
The National Health Service (NHS) Tayside Respiratory Disease Information System (TARDIS) was used to identify patients from January 2001 to January 2010 who had a documented diagnosis history of COPD. TARDIS was developed in 2001 to support primary-care practitioners and secondary-care pulmonologists in managing patients with COPD in Tayside, Scotland. Entry into TARDIS requires a diagnosis of COPD based on GOLD guidelines,1 comprising patient demographics, respiratory symptoms, lung function,
Results
A total of 2,853 patients with COPD were included in the study, of whom 1,857 were given ICS + LABA + Tio and 996 were given ICS + LABA. Mean ± SD FEV1 % predicted at study entry was 50.8% ± 17.1% and 62.7% ± 18.9%, respectively. Mean follow-up was 4.65 years (Table 1). The group receiving triple therapy, as expected, was more severe in terms of having a lower FEV1 % and oxygen saturation as measured by pulse oximetry but were otherwise closely matched. Of the patients within the ICS + LABA +
Discussion
To our knowledge, we have conducted the first retrospective cohort study directly comparing the additive benefits of tiotropium to combination therapy with ICSs and LABAs. We have shown by means of Cox regression and considering influential covariates that the addition of tiotropium has beneficial effects on all-cause mortality and mortality due to respiratory disease. Our understanding of COPD pharmacotherapy and its benefits stems from large clinical trials and various subgroup analyses.4, 6,
Acknowledgments
Author contributions: Dr B. J. Lipworth had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Short: contributed to the study concept and design; data acquisition, analysis, and interpretation; and drafting of the submitted manuscript, critical review for important intellectual content, and approval of the final version to be published.
Dr Williamson: contributed to the study concept and design; data
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Funding/Support: This study was supported by the University of Dundee.
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