Avtor/Urednik		Vogelmeier, Claus; Hederer, Bettina; Glaab, Thomas; Schmidt, Hendrik; Fležar, Matjaž; Ulčar-Kostič, Snežana; Maček-Cafuta, Arjana; Letonja, Saša; Smonkar, Tomaž; Vukelič, Katarina
Naslov		Tiotropium versus salmeterol for the prevention of exacerbations of COPD
Tip		članek
Vir		N Engl J Med
Vol. in št.		Letnik 364, št. 12
Leto izdaje		2011
Obseg		str. 1093-103
Jezik		eng
Abstrakt		Background: Treatment guidelines recommend the use of inhaled long-acting bronchodilators to alleviate symptoms and reduce the risk of exacerbations in patients with moderate-to-very-severe chronic obstructive pulmonary disease (COPD) but do not specify whether a long-acting anticholinergic drug or a ?(2)-agonist is the preferred agent. We investigated whether the anticholinergic drug tiotropium is superior to the ?(2)-agonist salmeterol in preventing exacerbations of COPD. Methods: In a 1-year, randomized, double-blind, double-dummy, parallel-group trial, we compared the effect of treatment with 18 ?g of tiotropium once daily with that of 50 ?g of salmeterol twice daily on the incidence of moderate or severe exacerbations in patients with moderate-to-very-severe COPD and a history of exacerbations in the preceding year. Results: A total of 7376 patients were randomly assigned to and treated with tiotropium (3707 patients) or salmeterol (3669 patients). Tiotropium, as compared with salmeterol, increased the time to the first exacerbation (187 days vs. 145 days), with a 17% reduction in risk (hazard ratio, 0.83; 95% confidence interval [CI], 0.77 to 0.90; P<0.001). Tiotropium also increased the time to the first severe exacerbation (hazard ratio, 0.72; 95% CI, 0.61 to 0.85; P<0.001), reduced the annual number of moderate or severe exacerbations (0.64 vs. 0.72; rate ratio, 0.89; 95% CI, 0.83 to 0.96; P=0.002), and reduced the annual number of severe exacerbations (0.09 vs. 0.13; rate ratio, 0.73; 95% CI, 0.66 to 0.82; P<0.001). Overall, the incidence of serious adverse events and of adverse events leading to the discontinuation of treatment was similar in the two study groups. There were 64 deaths (1.7%) in the tiotropium group and 78 (2.1%) in the salmeterol group. Conclusions: These results show that, in patients with moderate-to-very-severe COPD, tiotropium is more effective than salmeterol in preventing exacerbations. (Funded by Boehringer Ingelheim and Pfizer;
Deskriptorji		LUNG DISEASES, OBSTRUCTIVE BRONCHODILATOR AGENTS CHOLINERGIC ANTAGONISTS ADRENERGIC BETA-AGONISTS SPIROMETRY RANDOMIZED CONTROLLED TRIALS PROPORTIONAL HAZARDS MODELS PROBABILITY