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Superiority of "triple" therapy with salmeterol/fluticasone propionate and tiotropium bromide versus individual components in moderate to severe COPD.
Thorax. 2008 Jul; 63(7):592-8.T

Abstract

BACKGROUND

The combination of salmeterol and fluticasone propionate (SFC) and tiotropium bromide (TIO) are commonly used treatments in chronic obstructive pulmonary disease (COPD) but there are few data on their effectiveness when used together. We compared the effects of SFC 50/500 microg twice daily in addition to TIO 18 microg once daily with the individual treatments alone.

METHODS

41 patients with COPD participated in a randomised, double blind, double dummy, three way crossover study with 2 week washout periods between treatments. Lung function assessment included plethysmography and spirometry. The primary end point was post-dose specific airways conductance (sGaw) area under the curve (AUC(0-4 h)) on day 14.

RESULTS

AUC(0-4 h) sGaw was significantly higher on day 14 after SFC+TIO compared with TIO (22%) or SFC alone (27%) (both p<0.001). SFC+TIO significantly improved trough forced expiratory volume in 1 s compared with TIO alone (212 ml, p<0.001) and SFC alone (110 ml, p = 0.017) on day 14. Inspiratory capacity measurements also showed significant benefits for triple therapy over individual components on day 14. Subjects receiving SFC+TIO had clinically relevant improvements in Transition Dyspnoea Index (TDI) total score of 2.2 compared with TIO alone (p<0.001) (but not SFC alone, 0.7; NS) and used significantly less rescue medication (1.0 occasion less daily than TIO (p<0.001) and 0.6 less than SFC (p = 0.01)).

CONCLUSION

SFC+TIO triple therapy led to greater improvements in bronchodilation compared with TIO and SFC alone. The advantages of triple therapy are observed across a range of physiologically important parameters, including airway conductance and lung volumes. Triple therapy also led to patient related benefits by improving TDI and use of rescue medication.

Authors+Show Affiliations

Medicines Evaluation Unit, University Hospital of South Manchester, University of Manchester, Manchester M33 3TR, UK. dsingh@meu.org.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18245142

Citation

Singh, D, et al. "Superiority of "triple" Therapy With Salmeterol/fluticasone Propionate and Tiotropium Bromide Versus Individual Components in Moderate to Severe COPD." Thorax, vol. 63, no. 7, 2008, pp. 592-8.
Singh D, Brooks J, Hagan G, et al. Superiority of "triple" therapy with salmeterol/fluticasone propionate and tiotropium bromide versus individual components in moderate to severe COPD. Thorax. 2008;63(7):592-8.
Singh, D., Brooks, J., Hagan, G., Cahn, A., & O'Connor, B. J. (2008). Superiority of "triple" therapy with salmeterol/fluticasone propionate and tiotropium bromide versus individual components in moderate to severe COPD. Thorax, 63(7), 592-8. https://doi.org/10.1136/thx.2007.087213
Singh D, et al. Superiority of "triple" Therapy With Salmeterol/fluticasone Propionate and Tiotropium Bromide Versus Individual Components in Moderate to Severe COPD. Thorax. 2008;63(7):592-8. PubMed PMID: 18245142.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Superiority of "triple" therapy with salmeterol/fluticasone propionate and tiotropium bromide versus individual components in moderate to severe COPD. AU - Singh,D, AU - Brooks,J, AU - Hagan,G, AU - Cahn,A, AU - O'Connor,B J, Y1 - 2008/02/01/ PY - 2008/2/5/pubmed PY - 2008/7/22/medline PY - 2008/2/5/entrez SP - 592 EP - 8 JF - Thorax JO - Thorax VL - 63 IS - 7 N2 - BACKGROUND: The combination of salmeterol and fluticasone propionate (SFC) and tiotropium bromide (TIO) are commonly used treatments in chronic obstructive pulmonary disease (COPD) but there are few data on their effectiveness when used together. We compared the effects of SFC 50/500 microg twice daily in addition to TIO 18 microg once daily with the individual treatments alone. METHODS: 41 patients with COPD participated in a randomised, double blind, double dummy, three way crossover study with 2 week washout periods between treatments. Lung function assessment included plethysmography and spirometry. The primary end point was post-dose specific airways conductance (sGaw) area under the curve (AUC(0-4 h)) on day 14. RESULTS: AUC(0-4 h) sGaw was significantly higher on day 14 after SFC+TIO compared with TIO (22%) or SFC alone (27%) (both p<0.001). SFC+TIO significantly improved trough forced expiratory volume in 1 s compared with TIO alone (212 ml, p<0.001) and SFC alone (110 ml, p = 0.017) on day 14. Inspiratory capacity measurements also showed significant benefits for triple therapy over individual components on day 14. Subjects receiving SFC+TIO had clinically relevant improvements in Transition Dyspnoea Index (TDI) total score of 2.2 compared with TIO alone (p<0.001) (but not SFC alone, 0.7; NS) and used significantly less rescue medication (1.0 occasion less daily than TIO (p<0.001) and 0.6 less than SFC (p = 0.01)). CONCLUSION: SFC+TIO triple therapy led to greater improvements in bronchodilation compared with TIO and SFC alone. The advantages of triple therapy are observed across a range of physiologically important parameters, including airway conductance and lung volumes. Triple therapy also led to patient related benefits by improving TDI and use of rescue medication. SN - 1468-3296 UR - https://www.unboundmedicine.com/medline/citation/18245142/Superiority_of_"triple"_therapy_with_salmeterol/fluticasone_propionate_and_tiotropium_bromide_versus_individual_components_in_moderate_to_severe_COPD_ L2 - http://thorax.bmj.com/cgi/pmidlookup?view=long&amp;pmid=18245142 DB - PRIME DP - Unbound Medicine ER -