Multidetector-row computed tomography assessment of adding budesonide/formoterol to tiotropium in patients with chronic obstructive pulmonary disease - 02/02/13

Doi : 10.1016/j.pupt.2013.01.005

Hideki Yasui ^a, Naoki Inui ^a,^b,^⁎ , Kazuki Furuhashi ^a, Yutaro Nakamura ^a, Tomohiro Uto ^c, Jun Sato ^c, Kazumasa Yasuda ^c, Yasuo Takehara ^d, Takafumi Suda ^a, Kingo Chida ^a
^a Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan
^b Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Japan
^c Department of Respiratory Medicine, Iwata City Hospital, 513-2 Ohkubo, Iwata 438-8550, Japan
^d Department of Radiology, Hamamatsu University School of Medicine, Japan

Corresponding author. Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan. Tel.: +81 53 435 2263; fax: +81 53 435 2386.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 02 February 2013

Abstract

Background

In patients with chronic obstructive pulmonary disease (COPD), multidetector-row computed tomography (MDCT) showed that tiotropium dilated the inner diameters in airways from the third to the sixth generation of the bronchi. Here we aimed to evaluate the morphological effect by adding a budesonide/formoterol combination to tiotropium in COPD patients using three-dimensional MDCT.

Methods

Pulmonary function tests, St. George’s Respiratory Questionnaire (SGRQ) and MDCT imaging studies were performed at the beginning and after budesonide/formoterol combination treatment for 12 weeks in 14 patients with COPD.

Results

The median age was 73.5 years and the mean forced expiratory volume in 1 s (FEV₁) as a percentage of the predicted value was 57.2 ± 18.3%. The luminal area in the fifth generation bronchi and the emphysema volume/CT-derived total lung volume were significantly correlated with FEV₁ at baseline (r = 0.682, p < 0.02 and r = −0.868, p < 0.001, respectively). The average luminal area and wall area percentage in the third, fourth and fifth generations were correlated with the SGRQ total score. Budesonide/formoterol induced insignificant pulmonary function changes and significant symptoms improvement. CT images showed an increased inner luminal area and decreased wall area after budesonide/formoterol treatment. Average luminal area was significantly increased from 24.3 ± 9.7 to 26.0 ± 9.9 mm² in the third generation, 13.0 ± 6.5 to 14.7 ± 7.3 mm² in the fourth generation, 8.0 ± 4.8 to 9.4 ± 4.9 mm² in the fifth generation and 5.6 ± 2.7 to 6.7 ± 3.6 mm² in the sixth generation (p < 0.01). The average increase of the third generation luminal area was correlated with the FEV₁ increase (r = 0.632, p < 0.03). The wall area percentage significantly decreased from 51.5 ± 9.2 to 49.1 ± 9.7 in the third generation, 56.1 ± 9.7 to 53.0 ± 11.1 in the fourth generation, and 62.3 ± 9.9 to 57.6 ± 9.8 in the fifth generation (p < 0.05). Emphysema volume/CT-derived total lung volume was unchanged with treatment.

Conclusion

MDCT demonstrated budesonide/formoterol induced bronchodilation in the non-small airway. CT imaging can evaluate drug therapeutic effect and may provide additional insights into pharmacotherapy for COPD.

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Keywords : Airway, Budesonide/formoterol, Chronic obstructive pulmonary disease, Emphysema, Multidetector-row helical computed tomography