Tiotropium, If started early decreases annual FEV1 decline in COPD - Review - Dr. Adil Ramzan

Tiotropium is a long-acting muscarinic antagonist. Its effect last for 24 hours. It causes relaxation of smooth muscles of the respiratory tract and also helps to decrease the mucus secretion by goblet cells.

The chronic obstructive pulmonary disease is characterized by chronic productive cough and shortness of breath. The chronic obstructive pulmonary disease has two components; chronic bronchitis and emphysema. Chronic bronchitis is defined as a productive cough for 3 months for 2 consecutive years. On the other hand, emphysema occurs as a result of the destruction of alveolar walls and air entrapment in the alveoli.

The risk factors include cigarette smoking (the most common one), biomass fuel exposure, wood burning smoke, industrial smoke and occupational and chemical exposures, genetics and ageing also have a role in the development and progression of chronic obstructive pulmonary disease (COPD).

The noxious stimuli (eg. Cigarette smoke) damages the cilia (hair-like projections) present on the surface of the respiratory tract. The damaged cilia are unable to push the mucus out of the respiratory tract. Mucus starts to collect, can’t be cleared properly and thus cough occurs as an attempt to remove this mucus. The collection of mucus also results in bacterial overgrowth and chronic inflammation. Therefore, with the passage of time the bronchial wall thickening occurs due to the proliferation of lymphocytes and endothelial cells. The lumen narrows. Air pass through the narrowed lumen with difficulty as compared to the normal lumen. The patient uses accessory muscles in order to push the air in and out of the lungs. The alveoli lose their natural recoil and are unable to push the air out properly. The alveolar walls become weak and destroyed.

The COPD is classified into 4 types according to severity. Class 1, 2, 3, and 4. Class 1 is mild, 2 is moderate, 3 is severe and 4 and very severe COPD (GOLD staging).

Usually, COPD is not treated in stage 1 due to mild symptoms. Yumin Zhou et al. studied the use of tiotropium in early COPD and they found that the use of tiotropium slows the progression of COPD. The tiotropium use caused a lesser decline in FEV1 per year as compared to placebo, and also they found that FEV1 was generally higher in the treatment group as compared to placebo after 2 years of treatment and follow-up.

Thus one may consider adding tiotropium in early COPD instead of waiting for the COPD to progress in later stages, and then considering initiating tiotropium.