Tiotropium versus Salmeterol for the Prevention of Exacerbations of COPD

BACKGROUND Treatment guidelines recommend the use of inhaled long-acting bronchodilators to alleviate symptoms and reduce the risk of exacerbations in patients with moderate-tovery-severe chronic obstructive pulmonary disease (COPD) but do not specify whether a long-acting anticholinergic drug or a β2-agonist is the preferred agent. We investigated whether the anticholinergic drug tiotropium is superior to the β2-agonist salmeterol in preventing exacerbations of COPD. METHODS In a 1-year, randomized, double-blind, double-dummy, parallel-group trial, we compared the effect of treatment with 18 μg of tiotropium once daily with that of 50 μg of salmeterol twice daily on the incidence of moderate or severe exacerbations in patients with moderate-to-very-severe COPD and a history of exacerbations in the preceding year. RESULTS A total of 7376 patients were randomly assigned to and treated with tiotropium (3707 patients) or salmeterol (3669 patients). Tiotropium, as compared with salmeterol, increased the time to the first exacerbation (187 days vs. 145 days), with a 17% reduction in risk (hazard ratio, 0.83; 95% confidence interval [CI], 0.77 to 0.90; P<0.001). Tiotropium also increased the time to the first severe exacerbation (hazard ratio, 0.72; 95% CI, 0.61 to 0.85; P<0.001), reduced the annual number of moderate or severe exacerbations (0.64 vs. 0.72; rate ratio, 0.89; 95% CI, 0.83 to 0.96; P=0.002), and reduced the annual number of severe exacerbations (0.09 vs. 0.13; rate ratio, 0.73; 95% CI, 0.66 to 0.82; P<0.001). Overall, the incidence of serious adverse events and of adverse events leading to the discontinuation of treatment was similar in the two study groups. There were 64 deaths (1.7%) in the tiotropium group and 78 (2.1%) in the salmeterol group. CONCLUSIONS These results show that, in patients with moderate-to-very-severe COPD, tiotropium is more effective than salmeterol in preventing exacerbations. (Funded by Boehringer Ingelheim and Pfizer; ClinicalTrials.gov number, NCT00563381.

The IT Industry as a Driver of the Strategic Development of Ukraine's Economy in the Context of Digital Transformation

The purpose of the article is analyze the current state of the IT industry of Ukraine and determine its promising directions as a driver of the strategic development of Ukraine's economy in the context of digital transformation. By analyzing, systematizing and summarizing the scientific works of leading domestic and foreign scientists, the destabilizing factors of the development of the IT industry were determined, both the pre-war and the current state of the IT industry was analyzed, and the challenges and advantages of its operation in the strategic development of Ukraine were outlined. During the research, it was found that in the pre-war period, the IT industry of Ukraine was one of the largest exporters of IT services in European countries, with the growth by 25–30% every year, generating more than 4% of Ukraine's GDP. The current state of the IT industry in Ukraine, which is complicated by the state of war, economic instability, and systematic blackouts, is also analyzed. As a result of the research, the challenges that have a significant impact on the activities of the companies in the IT industry as a whole were identified and formulated. The advantages of the IT industry from the point of view of the global economy, for the State, for other branches of the economy, and for those employed in the field of IT technologies, are determined. Prospects for further research in this direction are the development of a set of measures to stimulate and develop the IT sphere of Ukraine, in particular at the State level, which would ensure sustainable development in both the long-term and the short-term perspective