Role of Inhaled Tiotropium on the Perioperative Outcomes of Patients with Lung Cancer and Chronic Obstructive Pulmonary Disease

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

lung cancer - pulmonary function - chronic obstructive pulmonary disease

Reference

• 1 Casaburi R, Mahler D A, Jones P W et al. A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease.  Eur Respir J. 2002;  19 217-224
• 2 O'Donnell D E, Flüge T, Gerken F et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD.  Eur Respir J. 2004;  23 832-840
• 3 Maltais F, Hamilton A, Marciniuk D et al. Improvements in symptom-limited exercise performance over 8 h with once-daily tiotropium in patients with COPD.  Chest. 2005;  128 1168-1178
• 4 Kobayashi S, Suzuki S, Niikawa H, Sugawara T, Yanai M. Preoperative use of inhaled tiotropium in lung cancer patients with untreated COPD.  Respirology. 2009;  14 675-679
• 5 Tashkin D P, Celli B, Senn S et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease.  N Engl J Med. 2008;  359 1543-1554
• 6 Hasegawa M, Makita H, Nasuhara Y et al. Relationship between improved airflow limitation and changes in airway caliber induced by inhaled anticholinergic agents in COPD.  Thorax. 2009;  64 332-338
• 7 Anzueto A, Tashkin D, Menjoge S, Kesten S. One-year analysis of longitudinal changes in spirometry in patients with COPD receiving tiotropium.  Pulm Pharmacol Ther. 2005;  18 75-81
• 8 Jones J G, Sapsford D J, Wheatley R G. Postoperative hypoxaemia: mechanisms and time course.  Anaesthesia. 1990;  45 566-573
• 9 Ueda K, Sudoh M, Jinbo M, Li T-S, Suga K, Hamano K. Physiological rehabilitation after video-assisted lung lobectomy for cancer: a prospective study of measuring daily exercise and oxygenation capacity.  Eur J Cardiothorac Surg. 2006;  30 533-537
• 10 Ueda K, Kaneda Y, Sudoh M et al. Role of quantitative CT in predicting hypoxemia and complications after lung lobectomy for cancer, with special reference to area of emphysema.  Chest. 2005;  128 3500-3506
• 11 Beckles M A, Spiro S G, Colice G L, Rudd R M. American College of Chest Physicians. The physiologic evaluation of patients with lung cancer being considered for resectional surgery.  Chest. 2003;  123 105S-114S
• 12 Butland R J, Pang J, Gross E R, Woodcock A A, Geddes D M. Two-, six-, and 12-minute walking tests in respiratory disease.  Br Med J (Clin Res Ed). 1982;  284 1607-1608
• 13 Park K J, Bergin C J, Clausen J L. Quantitation of emphysema with three-dimensional CT densitometry: comparison with two-dimensional analysis, visual emphysema scores, and pulmonary function test results.  Radiology. 1999;  211 541-547
• 14 Kinsella M, Muller N L, Abboud R T, Morrison N J, DyBuncio A. Quantitation of emphysema by computed tomography using a “density mask” program and correlation with pulmonary function tests.  Chest. 1990;  97 315-321
• 15 Lamers R J, Thelissen G R, Kessels A G, Wouters E F, van Engelshoven J M. Chronic obstructive pulmonary disease: evaluation with spirometrically controlled CT lung densitometry.  Radiology. 1994;  193 109-113
• 16 Ueda K, Kaneda Y, Sakano H, Tanaka T, Li T S, Hamano K. Obstacles for shortening hospitalization after video-assisted pulmonary resection for lung cancer.  Ann Thorac Surg. 2003;  76 1816-1820
• 17 Ueda K, Kaneda Y, Sudo M et al. Quantitative computed tomography versus spirometry in predicting air leak duration after major lung resection for cancer.  Ann Thorac Surg. 2005;  80 1853-1858
• 18 Filaire M, Bedu M, Naamee A et al. Prediction of hypoxemia and mechanical ventilation after lung resection for cancer.  Ann Thorac Surg. 1999;  67 1460-1465
• 19 Nagai K, Yoshida J, Nishimura M. Postoperative mortality in lung cancer patients.  Ann Thorac Cardiovasc Surg. 2007;  13 373-377
• 20 Ueda K, Tanaka T, Li T-S, Tanaka N, Hamano K. Quantitative computed tomography for the prediction of pulmonary function after lung cancer surgery: a simple method using simulation software.  Eur J Cardiothorac Surg. 2009;  35 414-418
• 21 Ueda K, Jinbo M, Li T-S, Yagi T, Suga K, Hamano K. Computed tomography-diagnosed emphysema, not airway obstruction, is associated with the prognostic outcome of early-stage lung cancer.  Clin Cancer Res. 2006;  12 6730-6736