Daily tiotropium improves lung function, but not exacerbation frequency in bronchiectasis

Daily tiotropium via the HandiHaler device improved lung function but did not reduce frequency of exacerbations over 6 months in patients with stable bronchiectasis, according to results published in European Respiratory Journal.

“In clinical practice, tiotropium bromide via the HandiHaler device has been prescribed for [more than] 15 years for patients with COPD, for whom it is has been shown to be highly effective in improving symptoms, exacerbations, quality of life, lung function and possible survival through airway bronchodilation and reduction in lung hyperinflation,” Lata Jayaram, MBChB, FRACP, PhD, consulting respiratory and sleep medicine physician and associate professor in the department of medicine at Western Health at the University of Melbourne, Australia, and colleagues wrote. “While [more than] 40% of patients with bronchiectasis have documented airflow obstruction, trials examining the usefulness of tiotropium in bronchiectasis are lacking.”

The randomized, placebo-controlled, two-period crossover trial included 90 adults with stable bronchiectasis from three hospitals in New Zealand. Patients were randomly assigned to daily tiotropium 18 µg (Spiriva, Boehringer Ingelheim) for 6 months followed by placebo for 6 months (n = 44; mean age, 62 years; 27% men) or vice versa (n = 46; mean age, 59.3 years; 48% men) with a washout period of 4 weeks for both groups. Eighty-five patients completed both treatment cycles.

The primary outcome was rate of event-based exacerbations during the 6-month treatment period.

The rate of exacerbations was 2.17 per year in the tiotropium group compared with 2.27 per year in the placebo group (RR = 0.96; 95% CI, 0.72-1.27; P = .77).

Compared with placebo, tiotropium treatment improved pre-bronchodilator FEV₁ by 58 mL (P = .002). According to the researchers, “[the] clinical relevance of this degree of improvement needs to be explored.”

Researchers reported similar adverse events with tiotropium and placebo. Respiratory events were the most commonly reported adverse event, in 47% and 49% of patients, respectively.

“Using tiotropium in the real world may provide additional information regarding its role in bronchiectasis, similar to that noted with COPD and severe asthma. While we do not recommend the routine use of tiotropium in bronchiectasis, patients could be given a trial of treatment if they have persistent symptoms such as breathlessness, cough and daily sputum production, since treatment options remain limited for this condition and the risk of adverse effects is low,” the researchers wrote.