New anticholinergic agent in

the treatment of COPD

Hadiarto Mangunnegoro
 Why doctors are reluctant to
treat COPD?

• Stop smoking is difficult

• No currently available drugs slow
progression
• Corticosteroids are in efffective
• Active inflammatory and destruction
process
GOLD Workshop Report
Four Components of COPD
Management
1. Assess and monitor
disease

2. Reduce risk factors

3. Manage stable COPD

 Education
 Pharmacologic
 Non-pharmacologic

4. Manage exacerbations
 Objectives of COPD
Management
• Prevent disease progression
• Relieve symptoms
• Improve exercise tolerance
• Improve health status
• Prevent and treat exacerbations
• Prevent and treat complications
• Reduce mortality
• Minimize side effects from treatment
 COPD management
Established Stop smoking
diagnosis Healthy lifestyle
Asses symptoms Immunisation

Treat obstruction BRONCHODILATORS

Assess hypoxemia Longterm oxygen therapy

Pulmonary rehabilitation.
program
Tiotropium bromide
 Tiotropium versus ipratropium:
Trough FEV1 response over 1 year
Tiotropium (n=356)
Ipratropium (n=179)
160
Trough FEV1 response (mL)

120
p<0.001 Tiotropium versus ipratropium at all time
80
points
40
150mL
Baseline
0

-40

-80
08 50 92 182 273 364

Day

Adapted from 64. Vincken, 2002

 Tiotropium versus ipratropium:
Improvement from baseline in trough
FVC over 1 year
400 Tiotropium (n=329)

350
300
 FVC (ml)

250
210ml
200
150
100
50 Ipratropium (n=161)

0
0 50 92 182 273 364

p<0.001
Test Day

Adapted from Vincken, 2000

 Tiotropium versus ipratropium:
Mean TDI focal score over 1 year

Tiotropium (n=356)
Ipratropium bromide (n=179)
1.5
* *
*
TDI focal score

1.0
Improvement

*
0.5 * *
0.0 0.9

-0.5

-1.0
0 100 200 300 400
Day
*p<0.05.

64. Vincken, 2002

 Final conclusions

• Tiotropium (SPIRIVA) is currrently the

treatment of choice for COPD