Yuji Oba, MD
Potential Financial Conflicts of Interest: None disclosed.
Oba Y.; Does Tiotropium Reduce Hospitalizations in Chronic Obstructive Pulmonary Disease?. Ann Intern Med. 2008;148:626. doi: 10.7326/0003-4819-148-8-200804150-00013
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Published: Ann Intern Med. 2008;148(8):626.
TO THE EDITOR:
Because no studies have shown a clear survival benefit with any inhaled therapies for chronic obstructive pulmonary disease (COPD), the next most important hard outcome would be hospitalization rates. In their systematic review, Wilt and colleagues (1) concluded that the reductions in hospitalizations with inhaled therapies were inconsistent, and evidence did not permit definitive conclusions about relative effectiveness. I agree that that is true with long-acting β-agonists (LABAs) and inhaled corticosteroids. However, recent meta-analyses have shown that tiotropium consistently reduced hospitalization rates in moderate-to-severe COPD (2, 3). Pooled analyses, including such recent studies as TORCH (Towards a Revolution in COPD Health) (4), were conducted to update previous studies, and tiotropium is still the only inhaled therapy that consistently and significantly reduced hospitalizations (Forest plots are available at http://pulmccm.blogspot.com) (5–14). Although the TORCH study showed a statistically significant reduction in hospitalizations with combined LABA and inhaled corticosteroid therapy, not enough data are available to conduct a pooled analysis on COPD-related hospitalizations. In a recent Canadian study (15), tiotropium also reduced hospitalizations when it was combined with an inhaled corticosteroid and an LABA but not when it was combined with an LABA alone. In conclusion, currently available evidence suggests that tiotropium or a combination of inhaled corticosteroid and LABA should be the therapy of choice in stable, moderate-to-severe COPD.
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