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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EA year of treatment with tiotropium significantly improved blood gas parameters in hypoxemic patients with severe chronic obstructive pulmonary disease, as compared with inhaled corticosteroids plus a long-acting beta-agonist.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Epulmonary clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Echronic obstructive pulmonary disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EA year of treatment with tiotropium significantly improved blood gas parameters in hypoxemic patients with severe chronic obstructive pulmonary disease (COPD), as compared with inhaled corticosteroids plus a long-acting beta-agonist (LABA), reported Maria-Christina L. Machado, MD, Federal University, Sao Paulo, Brazil.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EPartial arterial oxygen pressure (PaO\u003Csub\u003E2\u003C\/sub\u003E) increased significantly (p\u0026lt;0.001) from baseline and partial carbon dioxide pressure (PaCO\u003Csub\u003E2\u003C\/sub\u003E) decreased significantly (p\u0026lt;0.01) during treatment with tiotropium versus the standard therapy. Additionally, forced expiratory volume in one second (FEV\u003Csub\u003E1\u003C\/sub\u003E) increased significantly (p\u0026lt;0.001) with the bronchodilator compared with inhaled steroids plus LABA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003E\u201cThese results confirm that tiotropium usage has a significant impact on lung function variables, including arterial blood gas levels in hypoxemic stable outpatients with COPD under long-term oxygen therapy,\u201d said Dr. Machado.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDespite the proven benefits of tiotropium on lung function in COPD patients, the agent\u0027s impact on spirometric and arterial blood gas parameters remained uncertain in hypoxemic and severe COPD, according to Dr. Machado. In an effort to resolve the uncertainty, she and her colleagues evaluated outcomes in 67 consecutive patients with severe COPD and a requirement for long-term oxygen therapy. Each patient successively completed 12 months of treatment with each of two therapies: Treatment 1: inhaled steroids plus LABA; Treatment 2: inhaled corticosteroids + LABA and tiotropium. The primary objective was to compare the relative effects of the two therapeutic strategies on three parameters of lung function: PaO\u003Csub\u003E2\u003C\/sub\u003E, PaCO\u003Csub\u003E2\u003C\/sub\u003E, and FEV\u003Csub\u003E1\u003C\/sub\u003E.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAnalysis of baseline characteristics showed that the patients had a mean PaO\u003Csub\u003E2\u003C\/sub\u003E of 49.9 mm Hg, mean PaCO\u003Csub\u003E2\u003C\/sub\u003E of 47.9 mm Hg, and mean FEV\u003Csub\u003E1\u003C\/sub\u003E of 34% of predicted. After 12 months of treatment with inhaled corticosteroids and LABA, mean PaO\u003Csub\u003E2\u003C\/sub\u003E increased to 53.7 mm Hg and FEV\u003Csub\u003E1\u003C\/sub\u003E to 35% predicted, and PaCO\u003Csub\u003E2\u003C\/sub\u003E had decreased to 45.1 mm Hg.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ESuccessively, following 12 months of treatment with inhaled steroids plus LABA and tiotropium, mean PaO\u003Csub\u003E2\u003C\/sub\u003E was 57.4 mm Hg, PaCO\u003Csub\u003E2\u003C\/sub\u003E was 43.3 mm Hg, and FEV\u003Csub\u003E1\u003C\/sub\u003E was 38.1% predicted. All three parameters improved significantly as compared with the standard therapy (p\u0026lt;0.01 to p\u0026lt;0.001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/3\/9.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Changes in PaO2, PaCO2 and FEV1.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1923760678\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Changes in PaO\u0026amp;lt;sub\u0026amp;gt;2\u0026amp;lt;\/sub\u0026amp;gt;, PaCO\u0026amp;lt;sub\u0026amp;gt;2\u0026amp;lt;\/sub\u0026amp;gt; and FEV\u0026amp;lt;sub\u0026amp;gt;1\u0026amp;lt;\/sub\u0026amp;gt;.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/3\/9.2\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/3\/9.2\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/10\/3\/9.2\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11261\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EChanges in PaO\u003Csub\u003E2\u003C\/sub\u003E, PaCO\u003Csub\u003E2\u003C\/sub\u003E and FEV\u003Csub\u003E1\u003C\/sub\u003E.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from MC Machado, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThese results have potential implications for health policy and economics. The public health system of Brazil has provided patients access to inhaled corticosteroids plus LABA for severe asthma since 2002, but severe COPD patients from the Federal University of Sao Paulo started having access to these medicines in 2004. However, patients with severe COPD gained access to corticosteroids plus LABA and tiotropium only in 2007, provided by the public health system from the State Government of Sao Paulo.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EAfter July 2007, the opportunity to report pre- and posttiotropium experiences in a cohort of severe COPD patients who were enrolled in a long-term oxygen therapy (LTOT) program for hypoxemic COPD at the Federal University of Sao Paulo was available. Study results show significant improvement in lung function, including arterial blood gas levels, after tiotropium therapy in these patients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EAdditionally, because stable hypoxemic COPD outpatients experienced an improvement in all parameters after use of tiotropium and corticosteroids plus LABA and because severe hypoxemia, hypercapnia, and lung dysfunction are recognized independent markers of worst survival and usually are associated with frequent COPD hospitalization, this study suggests that the three drug combination can also bring clinical and socioeconomic benefits for these patients and health care systems.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/3\/9.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmsr1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmsr1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}