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Early Treatment of COPD Slows Disease Progression


Chronic obstructive pulmonary disease (COPD) is almost always caused by smoking. COPD encompasses two diseases: chronic bronchitis, in which the airways become inflamed; and emphysema, in which the air sacs in the lung are damaged. Both are progressive, getting worse over time.

Marc Decramer, MD, PhD, and colleagues have published an article in the journal Lancet showing that early treatment of lung disease slows progression of the disease.

They used data from the Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) study. UPLIFT was a randomised, double-blind, placebo-controlled trial undertaken in 487 centres in 37 countries.

UPLIFT enrolled 5993 patients aged 40 years or more with COPD. Each patient was randomly assigned to receive 4 years of treatment with either once daily tiotropium (Spiriva) or matching placebo, delivered by an inhalation device.

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In a prespecified subgroup analysis, Decramer and colleagues investigated the effects of tiotropium in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II disease. Patients in this subset who received Spiriva had a slower progression of their COPD. Treatment also reduced COPD exacerbations and improved quality of life over the four-year study.

"Treatment of COPD should begin in symptomatic patients with moderate [COPD] disease," conclude UPLIFT investigators Marc Decramer, MD, PhD, and colleagues.

In an editorial accompanying the study, University of Liverpool researchers Lisa Davies and Peter Calverley note that the improvements seen with Spiriva treatment were greater in early-stage patients than in late-stage patients.

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Effect of tiotropium on outcomes in patients with moderate chronic obstructive pulmonary disease (UPLIFT): a prespecified subgroup analysis of a randomised controlled trial; The Lancet, Early Online Publication, 28 August 2009 doi:10.1016/S0140-6736(09)61298-8; Marc Decramer, Bartolome Celli, Steven Kesten, Theodore Lystig, Sunil Mehra, Donald P Tashkin

UPLIFTing care for chronic obstructive pulmonary disease; The Lancet, Early Online Publication, 28 August 2009 doi:10.1016/S0140-6736(09)61518-X; Lisa Davies, Peter MA Calverley