Bronchodilator Effect of Tiotropium via Respimat(Ⓡ) Administered with a Spacer in Patients with Chronic Obstructive Pulmonary Disease (COPD)

OBJECTIVE: Among elderly patients with chronic obstructive pulmonary disease (COPD), there are some patients who cannot inhale tiotropium via Respimat(Ⓡ) due to poor hand-lung coordination. This study aimed to examine whether or not tiotropium inhalation therapy using Respimat(Ⓡ) with a spacer increased the forced expiratory volume in 1 s (FEV(1)) in patients with COPD. METHODS: A randomized, crossover, single-center study was conducted in 18 patients with stable COPD. Tiotropium (5 μg) via Respimat(Ⓡ) with or without a spacer (AeroChamber(Ⓡ)) was administered for 2 weeks. Following a 2-week washout period using a transdermal tulobuterol patch (2 mg per day), participants were then crossed over to the other inhalation therapy with respect to spacer use. The trough FEV(1) was measured at every visit using a spirometer. A questionnaire regarding inhalation therapy was administered to patients at the final visit. RESULTS: The administration of tiotropium via Respimat(Ⓡ) both with and without a spacer significantly increased the trough FEV(1) from baseline during each treatment period, with mean differences of 115.0±169.6 mL and 92.8±128.1 mL, respectively. There was no significant difference in the change in the trough FEV(1) between the 2 procedures (p=0.66). A total of 86% of patients reported that inhalation using a spacer was not difficult, and more than half also rated both the usage and maintenance of the AeroChamber(Ⓡ) as easy. CONCLUSION: Tiotropium inhalation therapy administered via Respimat(Ⓡ) using a spacer exerted a bronchodilatory effect similar to that observed with tiotropium Respimat(Ⓡ) alone.