Literature Review: The Clinical Effects of Tiotropium In Patients With Severe COPD

Whitireia Nursing Journal, 2007 by Parker, Tuppy

Abstract

Chronic Obstruction Pulmonary Disease (COPD) is characterised by a decline in lung function over time. The main risk factor for developing COPD is tobacco smoking. Symptoms of COPD include cough, sputum production and dyspnoea. These symptoms are disabling and have a substantial impact on a person's quality of life.

Tiotropium is a long-acting, once-daily anticholinergic medication used in the management of COPD. Benefits seen in overseas studies showed decreased frequency of exacerbations, decreased hospital admissions for exacerbations, improvements in pulmonary function tests and significant improvements in patient's self-reporting of 'well being' using health questionnaires.

There are limited studies to date that solely address those patients with very severe COPD and how best to measure their response to medications such as tiotropium. COPD is understood as very severe if the patient has a Forced Expiratory Volume in 1 second (FEV1) of less than 30% of predicted normal. This study looked at evaluating the clinical effects of tiotropium in patients with severe COPD using:

* measures of lung function (FEV1 and Forced Vital Capacity (FVC))

* functional capacity (Six Minute Walk Test (6MWT))

* self-reported dyspnoea (Borg score)

* nutritional requirements (Body Mass Index (BMI)).

A retrospective charts audit was undertaken by a respiratory nurse assessment clinic, known as a 'Spiriva clinic', to evaluate the effect of tiotropium on clinical outcome measures of respiratory function. A total of 32 patients met the inclusion criteria for this study. Data was divided into two to four weeks of tiotropium use and three months of tiotropium use.

The results showed no significant change in Borg scores at rest or post exercise. Six-minute walking distances showed small improvements, but these were not statistically significant. BMI values remained stable or increased slightly. FEV1 at two to four weeks (p

A dissertation submitted in partial fulfilment of the requirements for the Degree of Master of Health Science (Nursing)