tiotropium-bromide and Lung-Neoplasms

A new diagnosis of chronic obstructive pulmonary disease (COPD) is often made during the evaluation of patients requiring a surgical intervention for lung cancer. Based on initial impaired lung function, these untreated patients are often considered not fit for lung surgery. There is limited information on the short-term effectiveness of preoperative pharmacologic treatment strategies in patients with newly diagnosed COPD before lung surgery.. A prospective randomized study was conducted comparing 1-week-treatment periods of tiotropium/formoterol/budenoside (GR1) with tiotropium/formoterol (GR2) in conjunction with smoking cessation and chest physiotherapy. No patients had been previously treated for COPD. The primary end point was body plethysmography (forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), and airway resistance (RAW)) at the end of each treatment period. Secondary end points were improvement of ≥ 10% in FEV1 (% predicted) and improvement of the severity of COPD after the 1-week treatment, as well as the rate of pulmonary complications after surgery.. A total of 46 patients were randomized in GR1 (n=24) and GR2 (n=22). Both groups were comparable with regard to age, height, weight, smoking history, baseline body plethysmography (FVC, FEV1, and RAW), and the severity of COPD according to the Global Initiative for Obstructive Lung Disease (GOLD) staging, respectively. However, the short-term effects of the treatment with regard to FEV1 (2.0 l vs 1.7 l; p=0.031) and increase of FEV1 (0.31 l vs 0.10 l; p=0.02) were better in GR1. More patients in GR1 had an improvement of ≥ 10% in FEV1 (p=0.004) and improvement of the severity of COPD (p=0.012) after the 1-week treatment. Fewer pulmonary complications (11.1% vs 42.9%, p=0.04) were observed in GR1 after surgery.. Both therapies resulted in an improvement of lung function. There is benefit from adding inhalative budenoside to tiotropium and formoterol in terms of an improvement in FEV1 and the severity of COPD. These beneficial results might lead to less pulmonary complications in the postoperative period.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Aged; Airway Resistance; Bronchodilator Agents; Budesonide; Budesonide, Formoterol Fumarate Drug Combination; Carcinoma, Non-Small-Cell Lung; Drug Combinations; Drug Therapy, Combination; Epidemiologic Methods; Ethanolamines; Forced Expiratory Volume; Humans; Lung Neoplasms; Middle Aged; Plethysmography, Whole Body; Pneumonectomy; Preoperative Care; Pulmonary Disease, Chronic Obstructive; Scopolamine Derivatives; Smoking Cessation; Tiotropium Bromide; Treatment Outcome; Vital Capacity

Tiotropium, a long-acting bronchodilator, can be used perioperatively in patients with lung cancer and airway obstruction, although its benefits for the perioperative outcome remain unclear.. We prospectively collected the perioperative data of 44 patients with resectable lung cancer and untreated airway obstruction. Tiotropium was not used before September 2007 (control group, n = 24) but was used routinely thereafter (treated group, n = 20). We estimated a propensity score to adjust comparisons between the groups.. Tiotropium improved preoperative global pulmonary function significantly, especially in four patients. Postoperative outcomes in these major responders were significantly better than those in the remaining minor responders. However, postoperative outcomes were not significantly different between the treated group (n = 15) and the control group (n = 15) matched by a propensity score.. Regardless of its favorable effects on preoperative pulmonary function, we could not establish a significant benefit of tiotropium for postoperative outcomes overall. Nonetheless, our data suggested that tiotropium might have improved the postoperative outcomes of major responders.

Topics: Administration, Inhalation; Aged; Aged, 80 and over; Bronchodilator Agents; Female; Humans; Lung Neoplasms; Male; Perioperative Care; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Scopolamine Derivatives; Tiotropium Bromide; Treatment Outcome

The objective of this research was to explore the effect of the treatment regimen of Spiriva combined with Symbicort on the immune function of non-small-cell lung cancer (NSCLC) based on computed tomography (CT) imaging features. An automatic CT image segmentation algorithm (RW-CT) was constructed based on random walk (RW) and image segmentation technology. The image segmentation algorithm based on the Toboggan method (C-CT) was introduced to compare with the traditional RW algorithm. 60 subjects were divided into four groups: a Chinese combined with Western medicine group (treated with Spiriva combined with Symbicort, group C+W), a Chinese medicine group (treated with Spiriva, group C), a Western medicine group (treated with Symbicort, group W), and a model group for control (group M). The results show that the Dice coefficient of the RW-CT algorithm was obviously larger than that of the C-CT algorithm and the RW algorithm, while the Hausdorff distance (HD) of the RW-CT algorithm was much smaller than that of the other two algorithms (

Topics: Algorithms; Budesonide, Formoterol Fumarate Drug Combination; Carcinoma, Non-Small-Cell Lung; Humans; Image Processing, Computer-Assisted; Lung Neoplasms; Tiotropium Bromide; Tomography, X-Ray Computed; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factor Receptor-2

A new diagnosis of chronic obstructive pulmonary disease is often made during the evaluation of patients requiring lung cancer surgery. The objective of the present study was to evaluate the clinical effects of inhaled tiotropium on the postoperative cardiopulmonary complications in patients with untreated chronic obstructive pulmonary disease requiring lung cancer surgery.. A retrospective study involving 104 consecutive patients with moderate to severe chronic obstructive pulmonary disease who underwent a lobectomy for lung cancer at two specialized thoracic centers between April 2008 and October 2011 was performed. The results were compared between patients who did and did not receive inhaled tiotropium during the perioperative period. The primary endpoint was the incidence of postoperative cardiopulmonary complications. The postoperative white blood cell counts and C-reactive protein levels as biomarkers of inflammation were also examined.. The incidence of postoperative cardiopulmonary complications was significantly lower in the tiotropium group than in the control group (18 vs. 48 %, P = 0.001). Patients in the tiotropium group also showed significantly lower white blood cell counts and C-reactive protein levels postoperatively.. Inhaled tiotropium treatment during the perioperative period had a prophylactic effect on postoperative cardiopulmonary complications in patients with newly diagnosed chronic obstructive pulmonary disease requiring lung cancer surgery.

Topics: Administration, Inhalation; Aged; Bronchodilator Agents; Cardiovascular Diseases; Female; Humans; Lung Neoplasms; Male; Middle Aged; Perioperative Care; Pneumonectomy; Postoperative Complications; Pulmonary Disease, Chronic Obstructive; Respiration Disorders; Retrospective Studies; Scopolamine Derivatives; Tiotropium Bromide

Requirements for patient safety and improved efficacy are steadily increasing in modern healthcare and are key drivers in modern drug development. New drug characterization assays are central in providing evidence of the specificity and selectivity of drugs. Meeting this need, matrix-assisted laser desorption ionization-mass spectrometry imaging (MALDI-MSI) is used to study drug localization within microenvironmental tissue compartments. Thin sections of human lung tumor and rat xenograft tissues were exposed to pharmaceutical drugs by either spotting or submerging. These drugs, the epidermal growth factor receptor antagonists, erlotinib (Tarceva) and gefitinib (Iressa), and the acetylcholine receptor antagonist, tiotropium, were characterized by microenvironment localization. Intact tissue blocks were also immersed in drug solution, followed by sectioning. MALDI-MSI was then performed using a Thermo MALDI LTQ Orbitrap XL instrument to localize drug-distribution patterns. We propose three MALDI-MSI models measuring drug disposition that have been used to map the selected compounds within tissue compartments of tumors isolated from lung cancer patients.

Topics: Adenocarcinoma; Animals; Biological Transport; Cholinergic Antagonists; Erlotinib Hydrochloride; Gefitinib; Humans; Lung Neoplasms; Mice; Microtomy; Neoplasms, Experimental; Protein Kinase Inhibitors; Quinazolines; Scopolamine Derivatives; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Tiotropium Bromide; Tissue Culture Techniques; Tumor Microenvironment

The objective of the present study was to evaluate the effects of inhaled tiotropium on pulmonary function and left ventricular diastolic function in chronic obstructive pulmonary disease patients ≥ 1 year after pulmonary resection for lung cancer.. This prospective single-arm analysis involved 21 chronic obstructive pulmonary disease patients who underwent pulmonary resection for lung cancer at least one year earlier. Blood pressures, heart rate, spirometry, transthoracic echocardiography including tissue Doppler imaging, and quality of life were evaluated prior to and after 3 months of inhaled tiotropium treatment. B-type natriuretic peptide, white blood cell counts, and C-reactive protein levels before and after inhaled tiotropium treatment were also examined.. There were no significant differences between before and after treatment in forced vital capacity and left ventricular ejection fraction. Forced expiratory volume in 1 second and early transmitral velocity/tissue Doppler mitral annular early diastolic velocity values improved from 1.60 ± 0.5 L and 8.97 ± 1.6, respectively, before treatment, to 1.84 ± 0.5 L and 7.59 ± 1.4, respectively, 3 months after treatment (P <0.001).. Treatment with inhaled tiotropium may be effective in improving not only pulmonary function but also left ventricular diastolic function of patients with chronic obstructive pulmonary disease in the chronic phase after pulmonary resection.

Topics: Administration, Inhalation; Aged; Biomarkers; Bronchodilator Agents; Diastole; Echocardiography, Doppler; Female; Forced Expiratory Volume; Humans; Japan; Lung; Lung Neoplasms; Male; Middle Aged; Pilot Projects; Pneumonectomy; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Recovery of Function; Scopolamine Derivatives; Spirometry; Stroke Volume; Time Factors; Tiotropium Bromide; Treatment Outcome; Ventricular Function, Left; Vital Capacity

Topics: Bronchodilator Agents; Cardiovascular Diseases; Cause of Death; Cholinergic Antagonists; Drug Therapy, Combination; Humans; Lung Neoplasms; Pulmonary Disease, Chronic Obstructive; Scopolamine Derivatives; Tiotropium Bromide; Urinary Retention

Lung cancer patients with COPD are at high risk during surgery. Tiotropium, a long-acting bronchodilator, is a preferred maintenance therapy for COPD, but its efficacy in the perioperative period has not been clarified.. A retrospective review was performed of the medical records of 102 patients with primary lung cancer and COPD, who underwent scheduled surgery. Twenty-one lung cancer patients with untreated mild-to-severe COPD received tiotropium preoperatively. Spirometry was performed prior to and after 2 weeks of treatment with tiotropium, and at 3 months after surgery.. Two-week preoperative treatment with tiotropium significantly improved respiratory symptoms and pulmonary function as reflected by FVC (median 3.43 L pretreatment vs 3.52 L post-treatment), FEV(1) (median 2.06 L vs 2.32 L) and FEV(1)% (73.2% vs 81.0%) (all P < 0.001). Postoperative FEV(1)% was significantly increased from a median of 56.0% (interquartile range 51.6-60.3) to 63.4% (60.8-66.0) (P < 0.001). The increase in FEV(1) was inversely associated with severity of COPD (r = -0.59, P < 0.005). Lung resections were successfully accomplished without complications. The postoperative FEV(1) predicted prior to tiotropium treatment was underestimated (median predicted postoperative FEV(1) 1.65 L vs median measured postoperative FEV(1) 1.96 L, P < 0.001).. Preoperative treatment with tiotropium may facilitate surgical treatment for lung cancer patients with COPD. This is encouraging for COPD patients who may require curative lung resections.

Topics: Administration, Inhalation; Aged; Bronchodilator Agents; Dose-Response Relationship, Drug; Forced Expiratory Volume; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Preoperative Care; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Scopolamine Derivatives; Tiotropium Bromide; Treatment Outcome

Topics: Bronchodilator Agents; China; Dose-Response Relationship, Drug; Forced Expiratory Volume; Humans; Lung; Lung Neoplasms; Pulmonary Disease, Chronic Obstructive; Scopolamine Derivatives; Tiotropium Bromide; Treatment Outcome

It is well known that lung cancer patients with severe chronic obstructive pulmonary disease (COPD) have a higher risk of postoperative complications than patients without COPD. However, the information regarding preoperative treatment to improve pulmonary function of the lung cancer patients with severe COPD is limited. Here, we report 3 lung cancer cases with severe COPD. Although all patients received medication without tiotropium bromide in combination with pulmonary rehabilitation for 1 or 2 months, their pulmonary function did not improve and the predicted postoperative FEV1/predicted FEV1 was below 40% in all cases. After the approval in Japan for use of tiotropium bromide in the treatment of COPD, all patients were treated with tiotropium bromide. The pulmonary function in all patients improved 2-4 weeks after the start of tiotropium bromide, and we performed lobectomy safely. Currently all patients maintain good pulmonary function without recurrence of lung cancer. We propose that treatment of tiotropium bromide might be one of the effective preoperative methods to improve pulmonary function of lung cancer patients with severe COPD.

Topics: Aged; Bronchodilator Agents; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Male; Pneumonectomy; Postoperative Complications; Pulmonary Disease, Chronic Obstructive; Scopolamine Derivatives; Tiotropium Bromide