Clinical Efficacy Analysis of Tiotropium Bromide Combined with Budesonide and Formoterol Inhalation in Treating COPD

Objective:To analyze the clinical efficacy of tiotropium bromide(TB)combined with budesonide formoterol(BUD/FM)inhalation in treating chronic obstructive pulmonary disease(COPD).Methods:62 COPD patients admitted to the hospital between June 2020 and December 2022 were selected as samples for this study.The patients were divided into a combination group and a conventional group using the random number table method,with 31 cases in each group.The patients in the combination group were treated with TB combined with BUD/FM inhalation,whereas the patients in the conventional group were treated with BUD/FM inhalation only.The treatment efficacy and changes in lung function indicators of both groups were compared.Results:The total efficacy of treatment in the combined group was higher than that in the conventional group,and the difference was statistically significant(P<0.05).Before treatment,there was no difference in pulmonary function indicators between the two groups(P>0.05).After three months of treatment,all lung function indicators of the combined group were higher than those of the conventional group,and the difference was statistically significant(P<0.05).Conclusion:Combining TB with BUD/FM inhalation therapy increases the efficacy of treatment for patients with COPD.Besides,it also improves lung function and leads to a better prognosis.

Effects of Combined Inhalation of Budesonide,Formoterol,and Tiotropium Bromide on Arterial Blood Gas and Pulmonary Function Indexes in Patients with Chronic Obstructive Pulmonary Disease

Objective:To analyze the effect of combined inhalation of budesonide formoterol and tiotropium bromide on arterial blood gas and pulmonary function indexes in patients with chronic obstructive pulmonary disease(COPD).Methods:100 patients with COPD treated from January to December 2022 were selected as observation objects,and were divided into a control group(n=50,in which budesonide and formoterol were administered)and an experimental group(n=50,the treatment drug was budesonide formoterol combined with tiotropium bromide)according to the computer grouping method,and compared the treatment results.Results:(i)Before treatment,there was no difference in the partial pressure of carbon dioxide and partial pressure of oxygen between the control group and the experimental group(P>0.05);after treatment,the partial pressure of carbon dioxide and partial pressure of oxygen in the experimental group were higher than those in the control group,with significant differences(P<0.05).(ii)Before treatment,there was no difference in forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC between the control group and the experimental group(P>0.05);after treatment,the FVC,FEV1,and FEV1/FVC in the experimental group were significantly higher than those in the control group(P<0.05).(iii)There was no difference in the levels of CRP,IL-6,and TNF-αbetween the control group and the experimental group(P>0.05);after treatment,the levels of CRP,IL-6,and TNF-αin the experimental group were lower than those in the control group,with significant differences(P<0.05).(iv)Compared to the total incidence of adverse reactions in the control group(28.00%),the incidence of total adverse reactions in the experimental group was lower at 10.00%,and the difference was significant(P<0.05).Conclusion:The combined inhalation of budesonide and formoterol with tiotropium bromide has demonstrated a clear therapeutic efficacy and safety in treating chronic obstructive pulmonary disease.This treatment approach effectively enhances arterial blood gas levels and lung function,showing promising potential for widespread application.

Feasibility of Tiotropium Bromide Treatment in Patients with Asthma-COPD Overlap Syndrome and its Effect on Lung Function

Objective:To explore the feasibility of tiotropium bromide therapy and its effect on the lung function of patients with asthma-COPD overlap syndrome(ACOS).Method:The 58 subjects selected in this study were all ACOS patients admitted to our hospital(Hohhot First Hospital)from October 2020 to October 2022.They were grouped according to the random number table method and divided into a control group(29 cases)and an observation group(29 cases).The control group received routine treatment plus salmeterol-fluticasone powder inhalation treatment,and the observation group received tiotropium bromide treatment.The relevant indicators of the two groups were compared.Results:The total clinical effective rate of the observation group was significantly higher than that of the control group.Besides,the forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1)levels,and ACT scores of the two groups increased after treatment,with the observation group having better results than the control group.The residual volume-total lung capacity ratio(RV/TLC),acute exacerbation frequency,and CAT scores all decreased,with the observation group showing smaller values than the control group.The difference between the results of both groups were significant(P<0.05)Conclusion:Tiotropium bromide has a significant clinical effect in the treatment of ACOS patients and can effectively improve the lung function of patients.

Tiotropium Bromide/Olodaterol Related Acute Cognitive Impairments

Background: The use of anticholinergics has been on the rise. With the increase in population longevity, more medication-related cognitive impairments (ACIs) have been reported. These impairments result in significant morbidities. We present a case that stresses on the importance of being vigilant when prescribing anticholinergic medications, especially in the elderlies. Case Report: A case of ACIs related to the use of tiotropium bromide/olodaterol (Stiolto Respimat) is being reported in a 71-year-old white man with COPD. Treatment with budesonide 180 mcg/actuation, and tiotropium bromide/olodaterol (Stiolto Respimat) inhalers was initiated. Two days after initiating treatment, the patient developed ACIs which manifested by gait imbalance, short-term memory dysfunction, inability to remember his family members, or to take his medications. Tiotropium bromide/olodaterol (Stiolto Respimat) was discontinued. After three days, a full recovery of ACIs was reported. A month later, due to worsening dyspnea, the patient self-resumed the medicine. Similar ACIs were reported within two days of resuming treatment. Tiotropium bromide/olodaterol (Stiolto Respimat) was discontinued indefinitely. Full recovery of ACIs was reported. Conclusion: ACIs should be noted as a significant side effect of tiotropium bromide/olodaterol. Clinicians should be vigilant, when prescribing anticholinergic medications to elderlies.

Effect of Tiotropium Bromide on Expression of CD_8^+CD_(25)^+FoxP_3^+ Regulatory T Cells in Patients with Stable Chronic Obstructive Pulmonary Disease

The expression of CD8＋CD25＋FoxP3＋ regulatory T cells（CD8＋Tregs） in the peripheral blood of patients with stable chronic obstructive pulmonary disease（COPD）,and the effect of muscarinic cholinergic receptor antagonist tiotropium bromide on the expression of CD8＋Tregs were investigated.Twenty-three patients with moderate to severe stable COPD were enrolled in this study.All patients inhaled tiotropium bromide（18 μg daily） for 3 months.Before and after inhalation of tiotropium bromide,peripheral blood samples were collected from the patients,and T cells were labeled by three-color labeled monoclonal antibodies.Flow cytometry was used to detect the quantity and percentage of CD8＋T cells,CD8＋CD25＋T cells,CD8＋Tregs,CD4＋T cells,CD4＋CD25＋T cells and CD4＋CD25＋FoxP3＋ regulatory T cells（CD4＋Tregs） respectively.The percentage of CD4＋T cells was increased from（27.82±2.18）% to（35.53±1.3）%（t=3.20,P=0.004） in the peripheral blood of patients with stable COPD after inhalation of tiotropium bromide for 3 months,that of CD4＋CD25＋T cells was decreased from（10.03 ±1.42）% to（4.21 ±0.65）%（t=3.78,P=0.001）,and that of CD8＋Tregs was increased from（8.41 ±1.68）% to（21.34 ±4.20）%（t=2.72,P=0.013）.At baseline,CD8＋T cells,CD8＋CD25＋T cells and CD4＋Tregs were detectable in the peripheral blood,but no significant changes were observed after treatment.Linear correlation analysis revealed that the difference before and after treatment in CD4＋T cells and CD4＋CD25＋T cells was negatively correlated with the ratio of change in CD8＋Tregs before and after treatment（r=-0.61,P=0.013;r=-0.72,P=0.001 respectively）.In the peripheral blood of patients with stable COPD,there was the expression of CD8＋Tregs and CD4＋Tregs.Muscarinic receptor antagonist,tiotropium bromide,can promote the amplification of CD4＋T cells,inhibit the expression of CD25＋T cells,and enhance the expression of CD8＋Tregs.CD8＋Tregs and CD4＋Tregs can be used as new indicators to understand the immune status of patients.They are helpful in judging the treatment efficacy and disease immunophenotype.

Evaluation of the efficacy and safety of tiotropium bromide （5 μg） inhaled via Respimat in Chinese patients with chronic obstructive pulmonary disease

Background A pharmacokinetic study in an Asian population showed that tiotropium 5 μg via Respimat leads to the same plasma levels compared to 18 μg via HandiHaler.The objective of the trial was to compare the efficacy and safety of longterm treatment （1 year） with tiotropium bromide （5 μg） via Respimat（R） with placebo in patients with chronic obstructive pulmonary disease （COPD）.Methods A total of 3991 patients were randomized in this double-blind,placebo controlled,parallel group study,while in China 338 patients （309 males,29 females） received either tiotropium bromide （n=167） or placebo （n=171）.Tiotropium bromide solution or matching placebo was delivered via Respimat（R） at a dosage of 5 μg （2 x 2.5 μg/puff） once daily for 48 weeks.Co-primary endpoints were trough forced expiratory volume in one second （FEV1） and the time to first exacerbation.Results Statistically significant improvements in trough FEV1 and trough forced vital capacity （FVC） in the tiotropium group were achieved at weeks 4,24,and 48 compared with those in the placebo group.A statistically significant difference （P=0.0027） in favour of tiotropium was also observed for the time to first exacerbation.The total numbers of exacerbations during treatment were 90 and 128 in the tiotropium and placebo groups,respectively,with a rate ratio of 0.69 （P=0.0164）.The difference between the treatment groups in the adjusted mean changes from baseline of St.George Respiratory Questionnaire （SGRQ） total score was-3.9 （95% Cl：-7.5,-0.2） and was of statistical significance （P=0.0367）.The incidences of serious adverse events （SAEs） in the tiotropium and placebo groups were 16.2% and 17.0%,respectively.Seven deaths occurred whilst patients were on treatment,four in the tiotropium group and three in the placebo group,all of which were assessed as non-related study drugs by the investigators.Conclusions Tiotropium significantly improved lung function and quality of life,delayed the time to first exacerbation,reduced the number of exacerbations.Overall,tiotropium was well tolerated.