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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Does tiotropium lower exacerbation and hospitalization frequency in COPD patients? Results of a meta-analysis

Review published: 2010.

Bibliographic details: Van den Bruel A, Gailly J, Neyt M.  Does tiotropium lower exacerbation and hospitalization frequency in COPD patients? Results of a meta-analysis. BMC Pulmonary Medicine 2010; 10:50. [PMC free article: PMC2955630] [PubMed: 20858226]

Quality assessment

The authors concluded that tiotropium reduced the number of exacerbations and hospitalisations of chronic obstructive pulmonary disease (COPD) patients compared with placebo and ipratropium; compared with salmeterol, only the exacerbation frequency was reduced. Given the variability across trials, the possibility of inappropriate pooling and the poor quality of the evidence base, the authors? conclusions should be interpreted with caution. Full critical summary


BACKGROUND: International guidelines recommend long-acting bronchodilators in patients who remain symptomatic despite adequate treatment with short-acting bronchodilators. The purpose of this study is to estimate the effect of tiotropium, a long-acting anticholinergic inhalant, on exacerbation and hospitalisation frequency.

METHODS: Electronic databases (Medline, Embase, INAHTA, CRD databases, and the Cochrane Library) were searched for randomised controlled trials, comparing tiotropium to placebo, or other bronchodilators. Outcomes were the exacerbation frequency and hospitalisation frequency. Data were pooled using the generic inverse variance method for continuous outcomes.

RESULTS: Nine studies reported comparisons with placebo (n = 8), ipratropium (short-acting anticholinergic inhalant, n = 1), and salmeterol (long-acting β₂-agonist inhalant, n = 1). Only two studies reported adequate concealment of allocation. Tiotropium reduces the number of exacerbations per patient year by 0.31 (95% CI 0.46- 0.17) compared to placebo, and by 0.23 (95% CI 0.31- 0.15) compared to ipratropium. A significant difference in exacerbation frequency between tiotropium and salmeterol was found (-0.16; 95% CI -0.29 - -0.03) based on approximations of the results of one study.The number of hospitalisations is reduced by 0.04 (95% CI 0.08- 0.01) per patient year compared to placebo and by 0.06 (95% CI -0.09 - -0.03) per patient year compared to ipratropium.

CONCLUSIONS: Statistically significant but clinically small effects were found for tiotropium compared to placebo and ipratropium. The comparison with salmeterol is significant for exacerbation frequency but not for hospitalisation frequency. Publication bias may be present.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2013 University of York.

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