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Copyright ©ERS Journals Ltd 2007
Effect of tiotropium on sputum and serum inflammatory markers and exacerbations in COPD
1 Southend University Hospital, Westcliff-on-Sea, 2 Academic Unit of Respiratory Medicine, Royal Free and University College Medical School, London, and 3 Boehringer-Ingelheim, Bracknell, UK. 4 The present study was carried out while D.J. Powrie, T.M.A. Wilkinson, G.C. Donaldson and J.A. Wedzicha were affiliated to the Dept of Academic Respiratory Medicine, St Bartholomew’s Hospital, London, UK.
CORRESPONDENCE: J. A. Wedzicha, Academic Unit of Respiratory Medicine, Royal Free and University College Medical School, Rowland Hill Street, London, NW3 2PF, UK. Fax: 44 207472614. E-mail: j.a.wedzicha{at}medsch.ucl.ac.uk
Keywords: Anticholinergic, cytokines, sputum
Received: February 28, 2007
Accepted April 23, 2007
Chronic obstructive pulmonary disease (COPD) patients experiencing frequent exacerbations demonstrate increased stable-state airway inflammation. Tiotropium has been shown to reduce exacerbation frequency, but its effect on airway inflammation is unknown. The aim of the present study was to investigate the effect of tiotropium on sputum inflammatory markers and exacerbation frequency.
Patients (n = 142) were randomised to receive tiotropium or placebo in addition to their usual medication for 1 yr. Sputum and serum cytokines were assayed by ELISA and exacerbation frequency calculated using a symptom-based diary.
There was no difference in the area under the curve for sputum interleukin (IL)-6 or myeloperoxidase between the groups, but sputum IL-8 level was increased in the tiotropium arm. There was no difference between start and end of study in serum IL-6 or C-reactive protein level. Tiotropium was associated with a 52% reduction in exacerbation frequency (1.17 versus 2.46 exacerbations·yr–1). Of patients on tiotropium, 43% experienced at least one exacerbation, compared with 64% on placebo. The total number of exacerbation days was reduced compared with placebo (17.3 versus 34.5 days).
Tiotropium reduces exacerbation frequency in chronic obstructive pulmonary disease, but this effect does not appear to be due to a reduction in airway or systemic inflammation.
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