COPD in young patients: A pre-specified analysis of the four-year trial of tiotropium (UPLIFT)

Morice, A. H.; Celli, B.; Kesten, S.; Lystig, T.; Tashkin, D.; Decramer, M.

Abstract

Whilst recent large-scale studies have provided much evidence on the natural history and therapeutic response in patients with chronic obstructive pulmonary disease (COPD), relatively little is known about the effect in younger patients. We report a pre-specified post-hoc analysis of 356 patients with COPD ≤ 50 years old from the four year randomised, double blind placebo controlled Understanding Potential Long Term Impact on Function with Tiotropium (UPLIFT) trial. Inclusion criteria included a post-bronchodilator forced expiratory volume in 1 s (FEV1) of ≤70%, FEV1/FVC < 0.70, age ≥40 years, and smoking history of ≥10 pack years. Younger patients had a mean FEV1 of 1.24 L (39% predicted) and an impaired health-related quality of life (St. George's Respiratory Questionnaire (SGRQ)) compared to the entire UPLIFT population. There were 40.2% women and 51.1% current smokers in the younger age group. Tiotropium was associated with a sustained improvement in spirometry and SGRQ. Mean decline in post-bronchodilator FEV1 was 58 ml/year (placebo) vs. 38 ml/year (tiotropium) (p = 0.01). Corresponding values for pre-bronchodilator FEV 1 were 41 ml/year (placebo) compared with 34 ml/year (tiotropium) (p = 0.34). The hazard ratio (95%CI) for an exacerbation in the younger age group was 0.87(0.68, 1.13)). The rate of exacerbations was reduced by tiotropium (rate ratio (95%CI) = 0.73(0.56, 0.95)). Tiotropium resulted in sustained bronchodilation, improved quality of life, and a decreased exacerbation rate in younger patients. Tiotropium also resulted in a significant reduction in the decline in post-bronchodilator FEV1, suggesting possible disease modification by tiotropium in younger patients with COPD. © 2010 Elsevier Ltd. All rights reserved.

Citation

Morice, A. H., Celli, B., Kesten, S., Lystig, T., Tashkin, D., & Decramer, M. (2010). COPD in young patients: A pre-specified analysis of the four-year trial of tiotropium (UPLIFT). Respiratory medicine, 104(11), 1659-1667. https://doi.org/10.1016/j.rmed.2010.07.016

• Journal Article Type: Article
• Acceptance Date: Jul 26, 2010
• Online Publication Date: Aug 17, 2010
• Publication Date: Nov 1, 2010
• Deposit Date: May 24, 2022
• Journal: Respiratory Medicine
• Print ISSN: 0954-6111
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 104
• Issue: 11
• Pages: 1659-1667
• DOI: https://doi.org/10.1016/j.rmed.2010.07.016
• Keywords: Chronic obstructive pulmonary disease; Tiotropium; Age; Lung function
• Public URL: https://hull-repository.worktribe.com/output/3610310