![]() However, to date, there are relatively few data available on the impact of once-daily long-acting inhaled bronchodilators on night-time symptoms, either as reported by patients, or reflected in the use of rescue medication to control respiratory symptoms at night or in the morning. In comparison with tiotropium alone, the addition of an inhaled corticosteroid/long-acting beta-agonist (LABA) combination to tiotropium, was associated with fewer morning symptoms in patients treated with this more intensive regime. found that the long-acting anti-muscarinic drug tiotropium significantly reduced the degree of rapid-eye-movement sleep-related desaturation and improved post-sleep FEV 1 compared with placebo. The relationship of night-time and morning symptoms in COPD to changes in lung function is unclear, since relatively little attention has been paid to recording the time of day when symptoms are most prevalent. Although sleep quality is known to be poor in COPD, increased nocturnal symptoms in this population have only been demonstrated recently, and night-time awakening could be considered a potential surrogate for poor disease control. This change is enhanced in patients with asthma, who often complain of nocturnal respiratory symptoms, whereas, patients with chronic obstructive pulmonary disease (COPD) show falls in overnight FEV 1 similar to those seen in healthy individuals. ![]() There is a well-documented circadian rhythm in lung function, with forced expiratory volume in 1 s (FEV 1) falling by approximately 150 mL overnight in healthy subjects. The onset of sleep poses particular problems for the respiratory system. Following start of treatment, tiotropium decreased patients’ use of rescue medication compared with placebo, and morning and evening adjusted means for PEFR were higher for tiotropium compared with placebo. COPD-related night-time awakenings were associated with increased nocturnal rescue medication use and lower HRQoL ratings in both treatment arms. Over the 13-weeks’ treatment, tiotropium was associated with fewer night-time awakenings, with mean ± SE overall awakening scores per week of 0.356 ± 0.006 compared with 0.421 ± 0.007 for placebo ( p < 0.001) means were significantly lower for tiotropium versus placebo in patients with baseline awakenings ( p < 0.001), but not for those without baseline awakenings. At baseline, 280 (51.5 %) patients on tiotropium and 179 (50.1 %) on placebo reported ≥1 COPD-related night-time awakening per week. Data for night-time awakenings and albuterol use were available for 543 (99 %) patients on tiotropium and 352 (95 %) on placebo. ![]() Patients were aged 65.2 ± 8.7 years (mean ± SD), with a mean pre-bronchodilator FEV 1 of 36.1 ± 13.5 % predicted normal at baseline. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |