Indacaterol and tiotropium combination therapy in patients with chronic obstructive pulmonary disease

• Published in: Pulmonary pharmacology & therapeutics 2015-02, Vol.30, p.11-15
• Main Authors: Matsushima, Sayomi, Inui, Naoki, Yasui, Hideki, Kono, Masato, Nakamura, Yutaro, Toyoshima, Mikio, Shirai, Toshihiro, Suda, Takafumi
• Format: Article
• Language: English
• Subjects: Adrenergic beta-2 Receptor Agonists - administration & dosage; Adrenergic beta-2 Receptor Agonists - therapeutic use; Aged; Aged, 80 and over; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - therapeutic use; Chronic obstructive pulmonary disease; Combination therapy; Drug Therapy, Combination; Female; Forced Expiratory Volume - drug effects; Forced oscillation technique; Humans; Indacaterol; Indans - administration & dosage; Indans - therapeutic use; Male; Medical Education; Middle Aged; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary/Respiratory; Quinolones - administration & dosage; Quinolones - therapeutic use; Respiratory Function Tests; Scopolamine Derivatives - administration & dosage; Scopolamine Derivatives - therapeutic use; Tiotropium; Tiotropium Bromide; Treatment Outcome
• ISSN: 1094-5539; 1522-9629
• DOI: 10.1016/j.pupt.2014.10.003

Abstract Background Combination therapy with a long-acting antimuscarinic agent and a long-acting β2 -agonist are recommended in chronic obstructive pulmonary disease (COPD) if control is not adequate with one long-acting bronchodilator alone. We evaluated the effects of indacaterol and tiotropium combination therapy, including the effects of adding indacaterol to tiotropium (indacaterol add-on group) and adding tiotropium to indacaterol (tiotropium add-on group). Methods We recruited 79 patients with COPD already treated with tiotropium or indacaterol. We undertook pulmonary function tests, the COPD assessment test (CAT), and the multi-frequency forced oscillation technique (to measure respiratory resistance and reactance) before and after 8 weeks of indacaterol and tiotropium combination therapy. Results The median age was 72.1 years and the mean forced expiratory volume in 1 s (FEV1 ) as a proportion of predicted was 57.2 ± 18.3%. After 8 weeks of combination therapy, FEV1 and %predicted FEV1 had increased significantly. There was no change in CAT score. For respiratory impedance, combination therapy improved resistance at 5 Hz (R5) and resistance at 20 Hz (R20) in the whole-breath, inspiratory and expiratory phases, and resonant frequency (Fres) in the inspiratory phase. The indacaterol add-on group (43 patients) and tiotropium add-on group (36 patients) showed improvements in FEV1 and %predicted FEV1 over monotherapy, although the CAT score fell significantly in the indacaterol add-on group ( p  = 0.005). Conclusions Indacaterol and tiotropium combination therapy improved airflow limitation and respiratory resistances. Adding indacaterol to tiotropium, or tiotropium to indacaterol, had similar effects on airflow limitation.