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 Medjournal_title
Annals of internal medicineauthors
Niewoehner DE,Rice K,Cote C,Paulson D,Cooper JA Jr,Korducki L,Cassino C,Kesten Sdoi
10.7326/0003-4819-143-5-200509060-00007subject
Has Abstractpub_date
2005-09-06 00:00:00pages
317-26issue
5eissn
0003-4819issn
1539-3704pii
143/5/317journal_volume
143pub_type
临床试验,杂志文章,随机对照试验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
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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
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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
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