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Tiotropium

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https://www.readbyqxmd.com/read/29040210/anticholinergics-for-asthma-a-long-history
#1
Gustavo J Rodrigo
PURPOSE OF REVIEW: To provide a fast overview about the introduction and development of anticholinergic drugs in Western medicine to their current indications particularly in asthma. RECENT FINDINGS: Although short-acting muscarinic antagonists have been positioned in the last 15 years for the treatment of adults and children with moderate-to-severe acute asthma in the emergency setting (reducing the risk of hospital admissions and improving lung function), a growing body of evidence has recently emerged that positions the long-acting muscarinic anticholinergic tiotropium bromide as add-on therapy to at least inhaled corticosteroids (ICS) maintenance therapy in adults, adolescents, and children with symptomatic asthma...
October 16, 2017: Current Opinion in Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29030687/tolerability-of-bisoprolol-on-domiciliary-spirometry-in-copd
#2
Sunny Jabbal, Brian J Lipworth
We investigated if serial domiciliary measures of spirometry were sensitive at detecting subtle effects of beta-2 blockade associated with bisoprolol in (n = 17) patients with COPD. After a two-week run in on inhaled corticosteroid (ICS) and long acting beta-2 agonist (LABA): beclometasone/formoterol 100/6 µg, patients' started additional a long acting muscarinic receptor antagonist: (LAMA) Tiotropium 18 µg, with concomitant weekly dose titration of bisoprolol: 1.25-2.5-5 mg. After a further week of bisoprolol 5 mg, they were stepped back down to (ICS/LABA) for one week...
October 14, 2017: Lung
https://www.readbyqxmd.com/read/29025008/cardiopulmonary-interactions-with-beta-blockers-and-inhaled-therapy-in-copd
#3
S Jabbal, W Anderson, P Short, A Morrison, A Manoharan, B J Lipworth
Background: Beta-blockers remain underused in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular disease. Aim: We compared how different inhaled therapies affect tolerability of bisoprolol and carvedilol in moderate to severe COPD. Design: A randomized, open label, cross-over study. Methods: We compared the cardiopulmonary interactions of bisoprolol 5 mg qd or carvedilol 12.5 mg bid for 6 weeks in conjunction with: (i) triple: inhaled corticosteroid/long acting beta-agonist/long acting muscarinic antagonist (ICS + LABA + LAMA), (ii) dual: ICS + LABA and (iii) ICS alone...
July 24, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/28982946/role-of-bronchodilation-and-pattern-of-breathing-in-increasing-expiratory-flow-during-progressive-hypercapnia-in-chronic-obstructive-pulmonary-disease
#4
Kevin E Finucane, Bhajan Singh
Hypercapnia (HC) in-vitro relaxes airway smooth muscle; in-vivo it increases respiratory effort, tidal expiratory flows (V'exp), and, by decreasing inspiratory duration (Ti), increases elastic recoil pressure (Pel) via lung visco-elasticity; however, its effect on airway resistance is uncertain. We examined the contributions of bronchodilation, Ti and expiratory effort to increasing V'exp ̇with progressive HC in 10 COPD subjects, mean FEV1 53% predicted. Lung volumes (Vl), V'exp, esophageal pressure (Pes), Ti and end tidal PCO2 (PetCO2) were measured during 6 tidal breaths followed by an inspiratory capacity (IC), breathing air and at 3 levels of HC...
October 5, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28959443/effects-of-combination-therapy-indacaterol-glycopyrronium-versus-tiotropium-on-moderate-to-severe-copd-evaluation-of-impulse-oscillometry-and-exacerbation-rate
#5
Antonio Molino, Francesca Simioli, Anna Agnese Stanziola, Mauro Mormile, Maria Martino, Maria D'Amato
BACKGROUND: Small airways are considered the major site of airflow limitation in COPD. Impulse oscillometry (IOS) is a forced oscillation technique, which provides passive measurement of lung mechanics. It can differentiate small airway from large airway obstruction and is more sensitive than spirometry for peripheral airway disease. In this study the efficacy of the combination of Indacaterol/Glycopirronium (IND/GLY) versus Tiotropium on airway resistance (R5, R20, R5-20), lung reactance (X) and resonant frequency in moderate to severe COPD patients has been evaluated...
2017: Multidisciplinary Respiratory Medicine
https://www.readbyqxmd.com/read/28957643/the-effect-of-defining-copd-by-the-lower-limit-of-normal-of-fev1-fvc-ratio-in-tiospir-%C3%A2-participants
#6
Peter M A Calverley, Achim Mueller, Andrew Fowler, Norbert Metzdorf, Robert A Wise
RATIONALE: There is continuing debate about whether to define airflow obstruction by a postbronchodilator ratio of forced expiratory volume in 1 second and forced vital capacity below 0.70, or by ratio values falling below the age-dependent lower limit of normal derived from general population data. OBJECTIVE: To determine whether using the lower limit of normal criterion affects the classification and outcomes of patients previously defined as having chronic obstructive pulmonary disease by the fixed forced expiratory volume in 1 second and forced vital capacity ratio...
September 28, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28919143/long-term-safety-of-glycopyrrolate-eflow-%C3%A2-cs-in-moderate-to-very-severe-copd-results-from-the-glycopyrrolate-for-obstructive-lung-disease-via-electronic-nebulizer-golden-5-randomized-study
#7
Gary T Ferguson, Thomas Goodin, Robert Tosiello, Alistair Wheeler, Edward Kerwin
BACKGROUND: The use of long-acting bronchodilators is an essential component of the management of chronic obstructive pulmonary disease (COPD). The GOLDEN 5 Phase III, randomized, active-controlled, open-label study was conducted to evaluate the long-term safety and tolerability of a nebulized glycopyrrolate formulation (SUN-101) delivered via the investigational eFlow(®) Closed System (eFlow(®) CS) nebulizer in subjects with moderate-to-very-severe COPD. METHODS: Subjects were randomized in a 4:3 ratio to nebulized glycopyrrolate 50 μg twice daily (BID) or tiotropium 18 μg once daily (OD) and treated for 48 weeks...
August 24, 2017: Respiratory Medicine
https://www.readbyqxmd.com/read/28905245/identification-of-polymorphic-forms-of-active-pharmaceutical-ingredient-in-low-concentration-dry-powder-formulations-by-synchrotron-x-ray-powder-diffraction
#8
Kenji Egusa, Fumiaki Okazaki, Joerg Schiewe, Ulrike Werthmann, Markus Wolkenhauer
BACKGROUND: The identification of different (pseudo) polymorphs of an active pharmaceutical ingredient in dry powder formulations is of importance during development and entire product lifecycle, e.g., quality control. Whereas determination of polymorphic differences of pure substances is rather easy, in dry powder formulations, it is generally difficult and the difficulties increase particularly, if the substance of interest is present only in low concentrations in the formulation. Such a formulation is Spiriva(®) inhalation powder (Boehringer Ingelheim), which contains only 0...
September 13, 2017: Drugs in R&D
https://www.readbyqxmd.com/read/28877027/tiotropium-in-early-stage-chronic-obstructive-pulmonary-disease
#9
RANDOMIZED CONTROLLED TRIAL
Yumin Zhou, Nan-Shan Zhong, Xiaochen Li, Shuyun Chen, Jinping Zheng, Dongxing Zhao, Weimin Yao, Rongchang Zhi, Liping Wei, Bingwen He, Xiangyan Zhang, Changli Yang, Ying Li, Fenglei Li, Juan Du, Jianping Gui, Bin Hu, Chunxue Bai, Ping Huang, Gang Chen, Yongjian Xu, Changzheng Wang, Biao Liang, Yinhuan Li, Guoping Hu, Hui Tan, Xianwei Ye, Xitao Ma, Yan Chen, Xiwei Hu, Jia Tian, Xiaodan Zhu, Zhe Shi, Xiufang Du, Minjing Li, Shengming Liu, Ronghuan Yu, Jianping Zhao, Qianli Ma, Canmao Xie, Xiongbin Li, Tao Chen, Yingxiang Lin, Lizhen Zeng, Changxiu Ye, Weishu Ye, Xiangwen Luo, Lingshan Zeng, Shuqing Yu, Wei-Jie Guan, Pixin Ran
BACKGROUND: Patients with mild or moderate chronic obstructive pulmonary disease (COPD) rarely receive medications, because they have few symptoms. We hypothesized that long-term use of tiotropium would improve lung function and ameliorate the decline in lung function in patients with mild or moderate COPD. METHODS: In a multicenter, randomized, double-blind, placebo-controlled trial that was conducted in China, we randomly assigned 841 patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 (mild) or 2 (moderate) severity to receive a once-daily inhaled dose (18 μg) of tiotropium (419 patients) or matching placebo (422) for 2 years...
September 7, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28860828/the-evolving-role-of-tiotropium-in-asthma
#10
REVIEW
Emma R McIvor, R Andrew McIvor
Tiotropium is a long-acting muscarinic antagonist (LAMA) that exerts its bronchodilatory effect by blocking endogenous acetylcholine receptors in the airways. Its safety and efficacy are well established for the treatment of COPD, and it is now being recognized for its role in improving lung function and control in asthma. This review discusses the evolving role of tiotropium delivered by the Respimat(®) in patients across the range of asthma severities and ages, and provides an overview of safety and efficacy data...
2017: Journal of Asthma and Allergy
https://www.readbyqxmd.com/read/28858010/is-there-a-role-for-inhaled-anticholinergic-therapy-in-asthma-management
#11
Shannon M Parkey, Cortney M Mospan
Anticholinergic therapy has long been a cornerstone of management of chronic obstructive pulmonary disease (COPD) but has not been included in treatment guidelines for asthma. In September 2015, tiotropium bromide was approved for use in adults with asthma; the indication has since been expanded to children ages 6 years and older. This article discusses appropriate patient selection and dosing, and the role of tiotropium bromide in asthma management.
September 2017: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/28832630/long-term-treatment-with-budesonide-formoterol-attenuates-circulating-crp-levels-in-chronic-obstructive-pulmonary-disease-patients-of-group-d
#12
Yi-Hua Lin, Xi-Ning Liao, Li-Li Fan, Yue-Jin Qu, De-Yun Cheng, Yong-Hong Shi
BACKGROUND: The systemic inflammation is associated with clinical outcome and mortality in chronic obstructive pulmonary disease (COPD) patients. To investigate the effects of tiotropium (Tio) and/or budesonide/formoterol (Bud/Form) on systemic inflammation biomarkers in stable COPD patients of group D, a randomized, open-label clinical trial was conducted. METHODS: Eligible participants (n = 324) were randomized and received either Tio 18ug once daily (group I), Bud/Form 160/4...
2017: PloS One
https://www.readbyqxmd.com/read/28821260/24-h-bronchodilation-and-inspiratory-capacity-improvements-with-glycopyrrolate-formoterol-fumarate-via-co-suspension-delivery-technology-in-copd
#13
Colin Reisner, Gregory Gottschlich, Faisal Fakih, Andras Koser, James Krainson, Luis Delacruz, Samir Arora, Gregory Feldman, Krishna Pudi, Shahid Siddiqui, Chad Orevillo, Andrea Maes, Earl St Rose, Ubaldo Martin
BACKGROUND: Symptoms of chronic obstructive pulmonary disease may vary throughout the day and it is important that therapeutic approaches provide 24-h symptom control. We report the results of two phase IIIb crossover studies, PT003011 and PT003012, investigating the 24-h lung function profile of GFF MDI (glycopyrrolate/formoterol fumarate 18/9.6 μg delivered using innovative co-suspension delivery technology) administered twice daily. METHODS: Patients with moderate-to-very severe chronic obstructive pulmonary disease received 4 weeks' treatment with each of GFF MDI, placebo MDI, and open-label tiotropium (PT003011 only)...
August 18, 2017: Respiratory Research
https://www.readbyqxmd.com/read/28817781/availability-and-variation-of-publicly-reported-prescription-drug-prices
#14
Jeffrey T Kullgren, Joel E Segel, Timothy A Peterson, A Mark Fendrick, Simone Singh
OBJECTIVES: To examine how often retail prices for prescription drugs are available on state public reporting websites, the variability of these reported prices, and zip code characteristics associated with greater price variation. STUDY DESIGN: Searches of state government-operated websites in Michigan, Missouri, New York, and Pennsylvania for retail prices for Advair Diskus (250/50 fluticasone propionate/salmeterol), Lyrica (pregabalin 50 mg), Nasonex (mometasone 50 mcg nasal spray), Spiriva (tiotropium 18 mcg cp-handihaler), Zetia (ezetimibe 10 mg), atorvastatin 20 mg, and metoprolol 50 mg...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28814849/tiotropium-bromide-exerts-anti-inflammatory-effects-during-resistive-breathing-an-experimental-model-of-severe-airway-obstruction
#15
Dimitrios Toumpanakis, Konstantinos Loverdos, Vassiliki Tzouda, Vyronia Vassilakopoulou, Eleni Litsiou, Christina Magkou, Vassiliki Karavana, Michael Pieper, Theodoros Vassilakopoulos
INTRODUCTION: Resistive breathing (RB), a hallmark of obstructive airway diseases, is characterized by strenuous contractions of the inspiratory muscles that impose increased mechanical stress on the lung. RB is shown to induce pulmonary inflammation in previous healthy animals. Tiotropium bromide, an anticholinergic bronchodilator, is also shown to exert anti-inflammatory effects. The effect of tiotropium on RB-induced pulmonary inflammation is unknown. METHODS: Adult rats were anesthetized, tracheostomized and breathed spontaneously through a two-way non-rebreathing valve...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28810313/-efficacy-and-safety-of-tiotropium-respimat-in-the-treatment-of-chronic-obstructive-pulmonary-disease-systematic-review
#16
H D Cai, J Hou, Y N Lyu, L Xiong, M Z Lu, S L Wu
Objective: To evaluate the efficacy and safety of tiotropium Respimat in the treatment of chronic obstructive pulmonary disease (COPD) according to the Cochrane systematic evaluation. Methods: The Cochrane Library, PubMed, EMbase, CNKI, VIP and CBM, Wanfang Data were searched(from the foundation date to Jan. 2016) for the randomized controlled trials (RCTs) of tiotropium Respimat in the treatment of patients with COPD. Two reviewers independently retrieved the RCTs according to the inclusion and exclusion criteria, assessed the methodological quality of the included trials...
August 12, 2017: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/28808948/tiotropium-bromide-in-children-and-adolescents-with-asthma
#17
Hengameh H Raissy, H William Kelly
Evidence is emerging on the use of long-acting muscarinic antagonists (LAMAs) in the management of asthma. Tiotropium bromide (Spiriva(®) Respimat(®)) is the only LAMA approved in children and adolescents. As the use of tiotropium becomes more common in clinical practice, it is necessary to review the existing data to identify patients who may benefit from the addition of this medication to their daily asthma regimen. This review discusses recent evidence on the safety and efficacy of tiotropium bromide in the management of asthma in children and adolescents...
August 14, 2017: Paediatric Drugs
https://www.readbyqxmd.com/read/28775071/the-acute-effects-of-long-acting-bronchodilators-on-small-airways-detected-in-copd-patients-by-single-breath-n2-test-and-lung-p-v-curve
#18
Matteo M Pecchiari, Pierachille Santus, Dejan Radovanovic, Edgardo Giacomo D'Angelo
Small airways represent the key factor of chronic obstructive pulmonary disease (COPD) pathophysiology. The effect of different classes of bronchodilators on small airways is still poorly understood and difficult to assess. Hence, the acute effects of tiotropium (18 µg) and indacaterol (150 µg) on closing volume (CV) and ventilation inhomogeneity were investigated and compared in 51 stable patients (mean age (SD): 70±7 years; 82% males) with moderate to very severe COPD. Patients underwent body-plethysmography, arterial blood gas-analysis, tidal expiratory flow limitation (EFL), dyspnea assessment, and simultaneous recording of single breath nitrogen test (SBN) and transpulmonary pressure-volume curve (PL-V), before and one hour after drug administration...
August 3, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28767773/long-acting-muscarinic-antagonists-vs-long-acting-%C3%AE-2-agonists-in-copd-exacerbations-a-systematic-review-and-meta-analysis
#19
Israel Silva Maia, Mariângela Pimentel Pincelli, Victor Figueiredo Leite, João Amadera, Anna Maria Buehler
Objective: To determine whether long-acting muscarinic antagonists (LAMAs) provide superior therapeutic effects over long-acting β2 agonists (LABAs) for preventing COPD exacerbations. Methods: This was a systematic review and meta-analysis of randomized clinical trials involving patients with stable, moderate to severe COPD according to the Global Initiative for Chronic Obstructive Lung Disease criteria, treated with a LAMA (i.e., tiotropium bromide, aclidinium, or glycopyrronium), followed for at least 12 weeks and compared with controls using a LABA in isolation or in combination with a corticosteroid...
July 31, 2017: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
https://www.readbyqxmd.com/read/28745522/pharmacological-characterization-of-the-interaction-between-tiotropium-and-olodaterol-administered-at-5-5-concentration-ratio-in-equine-bronchi
#20
Luigino Calzetta, Paola Rogliani, Maurizio Mattei, Pietro Alfonsi, Giuseppe Cito, Elena Pistocchini, Mario Cazzola, Maria Gabriella Matera
Equine airways represent a suitable ex vivo model to study the functional impact of pharmacological treatments on human chronic obstructive pulmonary disorders, such as asthma and chronic obstructive pulmonary disease (COPD). We aimed to characterize the pharmacological interaction between the long-acting muscarinic antagonist (LAMA) tiotropium and the long-acting β2-agonist (LABA) olodaterol in equine airways. The effect of tiotropium and olodaterol, administered alone and in combination at the ratio of concentrations reproducing ex vivo the concentration-ratio delivered by the currently available fixed-dose combination (FDC) (5:5), was investigated on the cholinergic contractile tone induced by the parasympathetic activation of equine isolated airways...
July 26, 2017: COPD
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