Article thumbnail
Location of Repository

Small airways ventilation heterogeneity and hyperinflation in COPD: Response to tiotropium bromide

By Sylvia Verbanck, Daniël Schuermans and Walter Vincken


In chronic obstructive pulmonary disease (COPD) patients tiotropium bromide has been shown to improve forced expiratory volume in one second (FEV1) and inspiratory capacity (IC). We investigated whether the mechanism leading to these improvements is related to small airways ventilation heterogeneity, assessed by multiple breath washout tests. Forty stable tiotropium-free COPD patients (FEV1: 27%–78% predicted) were studied before and 90 min after administration of tiotropium bromide on visit0, and following 3 and 6 weeks of tiotropium bromide treatment (visit3wks, visit6wks). After study completion, COPD patients were classified into two subgroups according to degree of hyperinflation at visit0 (Hyp−, Hyp+). The Hyp+ group showed significant increases in trough (ie, pre-dose) FEV1 and IC after 3 and 6 weeks of tiotropium bromide, and the 90 min tiotropium bromide responses of FEV1 and IC were significant at visit0 (p ≤ 0.001 for both) but not during subsequent visits. The Hyp- group showed significant FEV1 increases 90 min after tiotropium bromide on all three visits (all p < 0.005) but no sustained increase in trough values. In both COPD subgroups, the grossly abnormal ventilation heterogeneity barely showed any significant improvements with tiotropium bromide in the conductive airways (without changes in trough value) and no changes at all in the acinar airways. We conclude that the sustained improvements in trough IC and FEV1 with tiotropium bromide predominantly observed in COPD patients with considerable hyperinflation, are unrelated to small airways ventilation heterogeneity

Topics: Original Research
Publisher: Dove Medical Press
OAI identifier:
Provided by: PubMed Central

Suggested articles


  1. (2002). A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease. Eur Respir J,
  2. (2000). A randomised controlled comparison of tiotropium and ipratropium in the treatment of chronic obstructive pulmonary disease. The Dutch Tiotropium Study Group.
  3. (1998). Conductive and acinar lung-zone contributions to ventilation inhomogeneity in COPD.
  4. (2004). Distribution of receptor targets in the lung.
  5. (2004). Effects of tiotropium on lung hyperinfl ation, dyspnoea and exercise tolerance in COPD.
  6. (2003). Health outcomes following treatment for six months with once daily tiotropium compared with twice daily salmeterol in patients with COPD.
  7. (2002). Improved health outcomes in patients with COPD during 1 yr’s treatment with tiotropium. Eur Respir J,
  8. (2005). Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD.
  9. (2003). Improvement in resting inspiratory capacity and hyperinfl ation with tiotropium in COPD patients with increased static lung volumes.
  10. (2005). Improvements in symptomlimited exercise performance over 8 h with once-daily tiotropium in patients with COPD.
  11. (2004). Noninvasive assessment of airway alterations in smokers: the small airways revisited.
  12. (2005). Prevention of exacerbations of chronic obstructive pulmonary disease with tiotropium, a once-daily inhaled anticholinergic bronchodilator: a randomized trial.
  13. Respir Crit Care Med,
  14. (2006). The effect of tiotropium on exacerbations and airfl ow in patients with COPD.
  15. (2006). The effect of tiotropium on hyperinfl ation and exercise capacity in chronic obstructive pulmonary disease.
  16. (1995). Tiotropium bromide (Ba 679 BR), a novel long-acting muscarinic antagonist for the treatment of obstructive airways disease. Life Sci,
  17. (2004). Tiotropium bromide.
  18. (1997). Ventilation distribution during histamine provocation.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.