Prevention of exacerbations of chronic obstructive pulmonary disease with tiotropium, a once-daily inhaled anticholinergic bronchodilator: a randomized trial.

Abstract:

BACKGROUND:Patients with chronic obstructive pulmonary disease (COPD) frequently develop exacerbations, leading to major clinical and health resource use ramifications. OBJECTIVE:To prospectively evaluate the effectiveness of a long-acting inhaled anticholinergic bronchodilator, tiotropium, in reducing COPD exacerbations and exacerbation-related health care utilization. DESIGN:Randomized, double-blind study. SETTING:26 Veterans Affairs medical centers. PATIENTS:1829 patients with moderate to severe COPD (mean baseline FEV(1), 36% predicted). INTERVENTION:Once-daily tiotropium (18 microg) or placebo for 6 months. Patients otherwise received usual care, except for other anticholinergic bronchodilators. MEASUREMENTS:The coprimary end points were the percentage of patients with a COPD exacerbation and the percentage of patients with a COPD-related hospitalization. RESULTS:Tiotropium significantly reduced the percentage of patients experiencing 1 or more exacerbations compared with placebo (27.9% vs. 32.3%, respectively; difference, -5.7 percentage points [95% CI, -10.4 to -1.0 percentage points]; P = 0.037). Fewer tiotropium patients were hospitalized because of COPD exacerbation (7.0% vs. 9.5%, respectively; difference, -3.0 percentage points [CI, -5.9 to -0.1 percentage points]; P = 0.056), although this difference was of borderline statistical significance. Analysis of secondary outcomes indicates that tiotropium may lengthen the time to first COPD exacerbation (P = 0.028) and reduce health care utilization for exacerbations, including the frequency of hospitalizations (P = 0.047), unscheduled clinic visits (P = 0.019), and days of antibiotic treatment (P = 0.015). Tiotropium did not statistically significantly reduce all-cause hospitalization rates. LIMITATIONS:Trial participants were enrolled from 1 health care system, and 99% were men. The follow-up period extended for only 6 months. CONCLUSIONS:Tiotropium reduces COPD exacerbations and may reduce related health care utilization in patients with moderate to severe COPD.

journal_name

Ann Intern Med

authors

Niewoehner DE,Rice K,Cote C,Paulson D,Cooper JA Jr,Korducki L,Cassino C,Kesten S

doi

10.7326/0003-4819-143-5-200509060-00007

subject

Has Abstract

pub_date

2005-09-06 00:00:00

pages

317-26

issue

5

eissn

0003-4819

issn

1539-3704

pii

143/5/317

journal_volume

143

pub_type

临床试验,杂志文章,随机对照试验
  • Efficacy and cost of low-molecular-weight heparin compared with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty.

    abstract:PURPOSE:To compare the efficacy, safety, and cost-effectiveness of low-molecular-weight heparin with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. DATA IDENTIFICATION:Studies were identified by MEDLINE search and review of bibliographies of retrieved articles. Hospital resou...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,meta分析

    doi:10.7326/0003-4819-119-11-199312010-00008

    authors: Anderson DR,O'Brien BJ,Levine MN,Roberts R,Wells PS,Hirsh J

    更新日期:1993-12-01 00:00:00

  • Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis: a randomized trial.

    abstract:BACKGROUND:Tumor necrosis factor-alpha is present in arteries in giant cell arteritis. OBJECTIVE:To evaluate the efficacy of infliximab, an anti-tumor necrosis factor-alpha agent, in giant cell arteritis. DESIGN:Randomized, controlled trial. SETTING:22 sites in the United States, the United Kingdom, Belgium, Italy, ...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.7326/0003-4819-146-9-200705010-00004

    authors: Hoffman GS,Cid MC,Rendt-Zagar KE,Merkel PA,Weyand CM,Stone JH,Salvarani C,Xu W,Visvanathan S,Rahman MU,Infliximab-GCA Study Group.

    更新日期:2007-05-01 00:00:00

  • Fatal and nonfatal hepatotoxicity associated with flutamide.

    abstract:OBJECTIVE:To identify and describe patients with hepatotoxicity possibly caused by flutamide, an antiandrogen drug. DESIGN:Case series of reports, submitted to the Adverse Drug Event Reporting System of the Food and Drug Administration. SETTING:Outpatient clinics and physicians' offices in the United States. PATIENT...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-118-11-199306010-00006

    authors: Wysowski DK,Freiman JP,Tourtelot JB,Horton ML 3rd

    更新日期:1993-06-01 00:00:00

  • Role of platelets in tumor cell metastases.

    abstract::Platelets may have a role in the development of animal tumor metastases. Ultrastructural studies in vivo have shown arrested tumor emboli surrounded by platelets. Several tumor cell lines induce thrombocytopenia in vivo. Certain tumor cells aggregate platelets in vitro. Correlations exist between the ability of some t...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-95-5-636

    authors: Karpatkin S,Pearlstein E

    更新日期:1981-11-01 00:00:00

  • Sites of conduction disease in aortic stenosis: significance of valve gradient and calcification.

    abstract::Electrophysiologic studies were done in 32 patients with aortic stenosis. In 24 patients with intact A-V conduction, A-H intervals ranged from 55 to 145 msec and were prolonged in two. Two had split His bundle potentials. The H-V intervals ranged from 25 to 94 msec and were prolonged in 12. The mean H-V interval was 6...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-87-3-275

    authors: Dhingra RC,Amat-y-Leon F,Pietras RJ,Wyndham C,Deedwania PC,Wu D,Denes P,Rosen KM

    更新日期:1977-09-01 00:00:00

  • Is there a role for maintaining sinus rhythm in patients with atrial fibrillation?

    abstract::Recent studies have indicated that outcomes in patients with atrial fibrillation who are managed with rate control and anticoagulation are similar to those in patients who have maintenance of sinus rhythm. These studies did not include important groups of patients with atrial fibrillation in whom antiarrhythmic therap...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-141-9-200411020-00015

    authors: Zimetbaum P,Josephson ME

    更新日期:2004-11-02 00:00:00

  • Acetaminophen does not impair clearance of zidovudine.

    abstract:OBJECTIVE:To determine whether concurrent treatment with acetaminophen and zidovudine impairs clearance of zidovudine, thereby increasing the risk for zidovudine-induced hematologic toxicity. DESIGN:Dose escalation, drug interaction study. SETTING:University clinical research center. PATIENTS:Patients with the acqui...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-114-11-937

    authors: Sattler FR,Ko R,Antoniskis D,Shields M,Cohen J,Nicoloff J,Leedom J,Koda R

    更新日期:1991-06-01 00:00:00

  • Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes.

    abstract:BACKGROUND:Angiotensin-converting enzyme (ACE) inhibitors slow renal disease progression and reduce cardiac morbidity and mortality in patients with diabetes. Patients' out-of-pocket costs pose a barrier to using this effective therapy. OBJECTIVE:To estimate the cost-effectiveness to Medicare of first-dollar coverage ...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-143-2-200507190-00007

    authors: Rosen AB,Hamel MB,Weinstein MC,Cutler DM,Fendrick AM,Vijan S

    更新日期:2005-07-19 00:00:00

  • Daily aspirin for primary prevention increased risk for major GI bleeding in healthy older adults.

    abstract:SOURCE CITATION:Mahady SE, Margolis KL, Chan A, et al. Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial. Gut. 2020. [Epub ahead of print.] 32747412. ...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/ACPJ202101190-004

    authors: Hirsch C

    更新日期:2021-01-01 00:00:00

  • Coronary morbidity and mortality, pre-existing silent coronary artery disease, and mild hypertension.

    abstract::Experimental findings in animals and epidemiologic studies in humans provide strong evidence that hypertension promotes the onset and progression of atherosclerosis. However, effective antihypertensive therapy has not consistently reduced the incidence of cardiac events in the major trials of treatment for mild hypert...

    journal_title:Annals of internal medicine

    pub_type: 临床试验,杂志文章,评审

    doi:10.7326/0003-4819-110-12-1017

    authors: O'Kelly BF,Massie BM,Tubau JF,Szlachcic J

    更新日期:1989-06-15 00:00:00

  • Does performance-based remuneration for individual health care practitioners affect patient care?: a systematic review.

    abstract:BACKGROUND:Pay-for-performance (P4P) is increasingly touted as a means to improve health care quality. PURPOSE:To evaluate the effect of P4P remuneration targeting individual health care providers. DATA SOURCES:MEDLINE, EMBASE, Cochrane Library, OpenSIGLE, Canadian Evaluation Society Unpublished Literature Bank, New ...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-157-12-201212180-00009

    authors: Houle SK,McAlister FA,Jackevicius CA,Chuck AW,Tsuyuki RT

    更新日期:2012-12-18 00:00:00

  • Vitamin-D-resistant osteomalacia in hemodialysis patients lacking secondary hyperparathyroidism.

    abstract::We describe a sporadic, vitamin-D-resistant osteomalacic syndrome in 19 patients undergoing hemodialysis. The syndrome was found in less than 1.5% of patients from referring dialysis centers. All 19 patients had multiple fractures, severe myopathy, and many developed spontaneous hypercalcemia. Severe osteomalacia with...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-94-5-629

    authors: Hodsman AB,Sherrard DJ,Wong EG,Brickman AS,Lee DB,Alfrey AC,Singer FR,Norman AW,Coburn JW

    更新日期:1981-05-01 00:00:00

  • Bilateral massive adrenal hemorrhage: early recognition and treatment.

    abstract:PURPOSE:To develop a clinical perspective on bilateral massive adrenal hemorrhage and an algorithm for its diagnosis and treatment. DATA IDENTIFICATION:Case reports were identified through a computer search using MEDLIN (1976 to 1987), and from bibliographies in review articles (up to 1978). STUDY SELECTION:Twelve re...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-110-3-227

    authors: Rao RH,Vagnucci AH,Amico JA

    更新日期:1989-02-01 00:00:00

  • Narrative review: reversible cerebral vasoconstriction syndromes.

    abstract::Reversible cerebral vasoconstriction syndromes (RCVS) comprise a group of diverse conditions, all characterized by reversible multifocal narrowing of the cerebral arteries heralded by sudden (thunderclap), severe headaches with or without associated neurologic deficits. Reversible cerebral vasoconstriction syndromes a...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-146-1-200701020-00007

    authors: Calabrese LH,Dodick DW,Schwedt TJ,Singhal AB

    更新日期:2007-01-02 00:00:00

  • Cardiovascular disease and mortality in older adults with small abdominal aortic aneurysms detected by ultrasonography: the cardiovascular health study.

    abstract:BACKGROUND:Persons with abdominal aortic aneurysm are more likely to have a higher prevalence of risk factors for and clinical manifestations of cardiovascular disease. It is unknown whether these factors explain the high mortality rate associated with abdominal aortic aneurysm. OBJECTIVE:To describe the risk for mort...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-134-3-200102060-00008

    authors: Newman AB,Arnold AM,Burke GL,O'Leary DH,Manolio TA

    更新日期:2001-02-06 00:00:00

  • Change in trans fatty acid content of fast-food purchases associated with New York City's restaurant regulation: a pre-post study.

    abstract:BACKGROUND:Dietary trans fat increases risk for coronary heart disease. In 2006, New York City (NYC) passed the first regulation in the United States restricting trans fat use in restaurants. OBJECTIVE:To assess the effect of the NYC regulation on the trans and saturated fat content of fast-food purchases. DESIGN:Cro...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-157-2-201207170-00004

    authors: Angell SY,Cobb LK,Curtis CJ,Konty KJ,Silver LD

    更新日期:2012-07-17 00:00:00

  • Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices.

    abstract::The Advisory Committee on Immunization Practices (ACIP) consists of 15 experts in immunization and related fields, selected by the Secretary of the U.S. Department of Health and Human Services, to provide advice and guidance on control of vaccine-preventable diseases. In its role as a federal advisory committee, the A...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-150-1-200901060-00009

    authors: Smith JC,Snider DE,Pickering LK,Advisory Committee on Immunization Practices.

    更新日期:2009-01-06 00:00:00

  • How variability in the institutional review board review process affects minimal-risk multisite health services research.

    abstract:BACKGROUND:The Department of Health and Human Services recently called for public comment on human subjects research protections. OBJECTIVE:To assess variability in reviews across institutional review boards (IRBs) for a multisite, minimal-risk trial of financial incentives for evidence-based hypertension care and to ...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.7326/0003-4819-156-10-201205150-00011

    authors: Petersen LA,Simpson K,Sorelle R,Urech T,Chitwood SS

    更新日期:2012-05-15 00:00:00

  • In unprotected left main CAD, revascularization with PCI and DES increased risk for MACCE vs CABG at 5 years.

    abstract:SOURCE CITATION:Holm NR, Mäkikallio T, Lindsay MM, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet. 2019;395:191-9. 31879028. ...

    journal_title:Annals of internal medicine

    pub_type: 评论,杂志文章

    doi:10.7326/ACPJ202005190-055

    authors: Vallabhajosyula S,Bell MR

    更新日期:2020-05-19 00:00:00

  • Predicting 6-Month Mortality for Older Adults Hospitalized With Acute Myocardial Infarction: A Cohort Study.

    abstract:Background:Older adults with acute myocardial infarction (AMI) have higher prevalence of functional impairments, including deficits in cognition, strength, and sensory domains, than their younger counterparts. Objective:To develop and evaluate the prognostic utility of a risk model for 6-month post-AMI mortality in ol...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/M19-0974

    authors: Dodson JA,Hajduk AM,Geda M,Krumholz HM,Murphy TE,Tsang S,Tinetti ME,Nanna MG,McNamara R,Gill TM,Chaudhry SI

    更新日期:2020-01-07 00:00:00

  • Thirty years of HIV and AIDS: future challenges and opportunities.

    abstract::As the third decade since AIDS was first recognized comes to an end, extraordinary advances have occurred in the understanding, treatment, and prevention of HIV infection and AIDS. As a result of these successes, it is now time to focus on future challenges. Paramount among these is reaching the goal of truly controll...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-154-11-201106070-00345

    authors: Dieffenbach CW,Fauci AS

    更新日期:2011-06-07 00:00:00

  • The anxiety disorders.

    abstract::Anxiety commonly accompanies serious illness. However, in some patients anxiety is the primary manifestation of illness. Diagnostic criteria for these "primary" anxiety disorders have been redefined in the most recent revision of the American Psychiatric Association's Diagnostic and Statistical Manual. We discuss thes...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-100-4-558

    authors: Brown JT,Mulrow CD,Stoudemire GA

    更新日期:1984-04-01 00:00:00

  • Type III hyperlipoproteinemia: diagnosis in whole plasma by apolipoprotein-E immunoassay.

    abstract::Because the cholesterol-rich very low density (VLD) lipoproteins of subjects with type III hyperlipoproteinemia are distinctively enriched in apolipoprotein E, a radial immunodiffusion assay for apolipoprotein E in whole plasma was developed. Its diagnostic usefulness was tested in randomly selected (n = 174) and hype...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-87-5-509

    authors: Kushwaha RS,Hazzard WR,Wahl PW,Hoover JJ

    更新日期:1977-11-01 00:00:00

  • Meta-analysis: apolipoprotein E genotypes and risk for coronary heart disease.

    abstract:BACKGROUND:Apolipoprotein E (apoE) genotypes play critical roles in lipid metabolism and are believed to influence risk for coronary heart disease (CHD). Despite many population studies, however, the impact of apoE polymorphism on risk for CHD remains uncertain. PURPOSE:To qualitatively and quantitatively assess the e...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,meta分析

    doi:10.7326/0003-4819-141-2-200407200-00013

    authors: Song Y,Stampfer MJ,Liu S

    更新日期:2004-07-20 00:00:00

  • Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration.

    abstract::The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) Statement includes a 22-item checklist, which aims to improve the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. The TRIPOD Statement...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/M14-0698

    authors: Moons KG,Altman DG,Reitsma JB,Ioannidis JP,Macaskill P,Steyerberg EW,Vickers AJ,Ransohoff DF,Collins GS

    更新日期:2015-01-06 00:00:00

  • Incidence of type 2 diabetes in the randomized multiple risk factor intervention trial.

    abstract:BACKGROUND:Weight loss and increased physical exercise reduce the risk for diabetes in people with impaired glucose tolerance. Randomized trial evidence on the effect of these interventions on people without impaired glucose tolerance is lacking. OBJECTIVE:To examine the influence of a comprehensive intervention progr...

    journal_title:Annals of internal medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.7326/0003-4819-142-5-200503010-00006

    authors: Davey Smith G,Bracha Y,Svendsen KH,Neaton JD,Haffner SM,Kuller LH,Multiple Risk Factor Intervention Trial Research Group.

    更新日期:2005-03-01 00:00:00

  • Risk for the acquired immunodeficiency syndrome among thrombocytopenic and nonthrombocytopenic homosexual men seropositive for the human immunodeficiency virus.

    abstract::A group of 44 homosexual patients with immune thrombocytopenia and serologic evidence of infection with the human immunodeficiency virus (HIV) was observed for a total of 844 person-months. The risk of developing the acquired immunodeficiency syndrome (AIDS), an actuarial incidence of 36.5% in 37 months, was no differ...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-106-3-383

    authors: Holzman RS,Walsh CM,Karpatkin S

    更新日期:1987-03-01 00:00:00

  • Serratia marcescens endocarditis: a regional illness associated with intravenous drug abuse.

    abstract::From 1969 to 1974, 19 cases of Serratia marcescens endocarditis were observed in the San Francisco Bay Area. Seventeen patients were intravenous drug users, and Serratia caused 14% of all addict-associated endocarditis in San Francisco. Serratia strains were nonpigmented and had typical antibiotic sensitivities, excep...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-84-1-29

    authors: Mills J,Drew D

    更新日期:1976-01-01 00:00:00

  • Effect of nasogastric tube size on gastroesophageal reflux and microaspiration in intubated patients.

    abstract:BACKGROUND:Little evidence exists to support the theory that small-bore nasogastric tubes prevent gastroesophageal reflux and microaspiration in intubated patients. OBJECTIVE:To determine whether gastroesophageal reflux and microaspiration in intubated patients can be reduced by the use of a small-bore nasogastric tub...

    journal_title:Annals of internal medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.7326/0003-4819-130-12-199906150-00007

    authors: Ferrer M,Bauer TT,Torres A,Hernández C,Piera C

    更新日期:1999-06-15 00:00:00

  • Should This Patient Receive Aspirin?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

    abstract::Aspirin exerts antiplatelet effects through irreversible inhibition of cyclooxygenase-1, whereas its anticancer effects may be due to inhibition of cyclooxygenase-2 and other pathways. In 2009, the U.S. Preventive Services Task Force endorsed aspirin for primary prevention of cardiovascular disease. However, aspirin's...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/M17-2162

    authors: Burns RB,Graham K,Sawhney MS,Reynolds EE

    更新日期:2017-12-05 00:00:00