Background Glycopyrronium (GLY) has demonstrated efficacy similar to open-label and single-blinded tiotropium (TIO) in the treatment of COPD and fast onset of bronchodilation action.^1,2 The double-blinded FAST study compared the efficacy of GLY with TIO in serial spirometry and bodyplethysmography measurements to allow for a more intensified characterisation of the earlier onset of action.

Methods In this multicenter, randomised, double-blinded, double-dummy, cross-over study patients (pts) with moderate-to-severe COPD received single-dose of both once- daily GLY 44 μg and TIO 18 μg via the Breezhaler® and Handihaler® devices respectively. Primary endpoint was the forced expiratory volume in one second (FEV₁) AUC _–2h. Other endpoints included inspiratory capacity (IC), residual volume (RV), functional residual capacity (FRC) and specific airway resistance (sRaw), all measured by bodyplethysmography.

Results Of 152 pts randomised (mean age: 61.8 yr, mean post-bronchodilator FEV₁: 52.1%) 99.3% completed the study. After inhalation of the single dose, GLY demonstrated superiority to TIO in early bronchodilation i.e. FEV₁ AUC _–2h (least squares mean (LSM) = 0.037 L, p = 0.0006). Both treatments showed similar improvements in IC, RV, and FRCpleth. Over the first 90 min after dosing, GLY also showed statistically significant improvement in sRaw compared to TIO with a difference of 0,184 kPa*s at the time point 90 min (LSM, p = 0.006).

Conclusion GLY showed effective bronchodilation and was superior to double-blinded TIO in terms of early onset of bronchodilation. Both GLY and TIO showed similar improvements in static lung volume parameters; however GLY was superior in reduction of sRaw early after inhalation.

References 1 Kerwin E, et al. Eur Resp J 2012;40:1106–1114

2 Chapman, et al. BMC Pulm Med. 2014;14:4