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Acute bronchodilator responsiveness to tiotropium in postinfectious bronchiolitis obliterans in children
Mariângela F C Teixeira1, Joaquim C Rodrigues1, Claudio Leone2
1Pulmonology Division, College of Public Health, University of São Paulo, São Paulo, Brazil.
Insights
Tiotropium bromide significantly improved lung function in children with postinfectious bronchiolitis obliterans (PIBO) by reducing airway obstruction and air trapping for up to 24 hours. This study highlights tiotropium
Area of Science:
- Pediatric Pulmonology
- Respiratory Pharmacology
Background:
- Postinfectious bronchiolitis obliterans (PIBO) typically causes severe airflow obstruction.
- Children with PIBO often show limited response to standard bronchodilators like beta-adrenergic drugs.
- The efficacy of anticholinergic agents, such as tiotropium bromide, in PIBO is not well-established.
Purpose of the Study:
- To investigate the acute bronchodilator effects of tiotropium bromide in children diagnosed with PIBO.
- To assess the duration of tiotropium's effect on lung function parameters for up to 24 hours.
- To compare the bronchodilator response to tiotropium versus placebo in this pediatric population.
Main Methods:
- A randomized, double-blind, placebo-controlled, crossover study involving 30 children (aged 6-16 years) with stable PIBO.
- Lung function was measured using spirometry and plethysmography before and at multiple time points (30 min to 24 h) after inhaling either 18 μg of tiotropium or a placebo.
- Statistical analysis, including ANOVA and Friedman tests, was used to compare changes in lung function parameters between the tiotropium and placebo groups relative to baseline.
Main Results:
- Tiotropium inhalation led to statistically significant improvements in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and forced expiratory flow between 25% and 75% of FVC (FEF25%-75%) compared to baseline.
- Significant reductions in residual volume (RV), total lung capacity (TLC), RV/TLC ratio, airway resistance (Raw), and improvements in specific airway conductance (sGaw) were observed post-tiotropium.
- No significant changes in lung function parameters were noted in the placebo group, and all observed improvements with tiotropium were statistically significant compared to placebo.
Conclusions:
- Tiotropium bromide demonstrated acute efficacy in reducing airway obstruction and air trapping in children with PIBO.
- The bronchodilator effects of tiotropium persisted for up to 24 hours post-inhalation.
- These findings suggest tiotropium bromide as a potential therapeutic option for managing airway obstruction in pediatric PIBO.
Background:
Patients with postinfectious bronchiolitis obliterans (PIBO) usually have severe airflow obstruction and respond poorly to β-adrenergic drugs. However, the bronchodilator response to an anticholinergic agent such as tiotropium bromide is not known. We studied the acute bronchodilator response to tiotropium for up to 24 h in children with PIBO using spirometric and plethysmographic criteria.
Methods:
A randomized, double-blind, placebo-controlled, crossover, prospective study was performed in patients with stable PIBO, 6 to 16 years of age. Standard spirometry and plethysmography were performed before and at 30, 60, 120, and 180 min and 24 h after inhalation of 18 μg of tiotropium or a placebo. After 7 to 14 days, the drugs were inverted, and the procedures were repeated. The changes in lung function parameters at each time point were compared with the baseline by analysis of variance and Tukey posttest, and the differences in all time points assessments vs baseline in tiotropium vs placebo groups were compared using the Friedman test.
Results:
A total of 30 patients were enrolled in the study (23 boys, seven girls; aged 10.9 ± 2.8 years) with baseline lung function values (% predicted) of FVC, FEV1, FEV1/FVC, forced expiratory flow between 25% and 75% of FVC (FEF25%-75%), total lung capacity (TLC), residual volume (RV), RV/TLC, airway resistance (Raw), and specific airway conductance (sGaw) of 75 ± 15, 48 ± 14, 59 ± 11, 22 ± 11, 120 ± 19, 281 ± 101, 49 ± 13, 250 ± 65, and 23 ± 9, respectively. Statistically significant differences were observed after tiotropium inhalation in the following parameters compared with baseline: FVC at 60, 120, and 180 min and 24 h; FEV1 at 30, 60, 120, and 180 min; FEV1/FVC at 60, 120, and 180 min; FEF25%-75% at 60, 120, and 180 min; RV at 30, 60, 120, and 180 min; TLC at 30, 120, and 180 min; RV/TLC at 30, 60, 120, and 180 min; Raw at 30, 60, 120, and 180 min and 24 h; and sGaw at 30, 60, 120, and 180 min and 24 h. For the placebo group, no significant differences were observed in any lung function parameters at any time. The differences in the main functional measurements between the tiotropium and placebo groups were statistically significant.
Conclusions:
Tiotropium acutely decreased airway obstruction and air trapping for up to 24 h in children with PIBO.
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