Computed tomography (CT)-assessed bronchodilation induced by inhaled indacaterol and glycopyrronium/indacaterol in COPD

Respir Med. 2016 Oct:119:70-77. doi: 10.1016/j.rmed.2016.08.020. Epub 2016 Aug 23.

Abstract

Background: Our previous studies suggested that the site of bronchodilation on CT might differ between inhaled β2 agonists and inhaled anticholinergics in COPD.

Aim: To assess and compare the bronchodilation effects of inhaled indacaterol and glycopyrronium/indacaterol by airway generation in large airways using CT.

Methods: CT scans at full inspiration and pulmonary function tests were done in 25 patients with moderate-severe COPD before and 4-5 weeks after daily inhalation of indacaterol and again another 4-5 weeks after inhalation of glycopyrronium/indacaterol. Airway inner luminal area (Ai) at the 3rd (segmental) to 6th generation of 8 selected bronchi, a total of 32 sites, in the right lung was analyzed on 3 occasions. Our proprietary software enables us to select the same airways and the same measurement sites for comparison, with simultaneous confirmation using two screens on the computer.

Results: The overall increase of Ai (ΔAi, %) averaged at all 32 measurement sites induced by glycopyrronium/indacaterol had a significant correlation with FEV1 improvement (r = 0.7466, p < 0.0001). Both ΔAi, % with indacaterol and ΔAi, % with additional glycopyrronium were significant at the 3rd to 6th generations. Remarkable increases in ΔAi, % were found at the 5th and 6th generations in several subjects with indacaterol or additional glycopyrronium. There were no significant site-differences in the bronchodilation pattern caused by indacaterol and by glycopyrronium/indacaterol at any of the 3rd to 6th generations.

Conclusions: Additional bronchodilation with glycopyrronium was demonstrated by CT at the 3rd to 6th generations, with no site-specific differences in bronchodilation between indacaterol and glycopyrronium/indacaterol. This study was registered in the UMIN Clinical Trials Registry (UMIN-CTR) system (http://www.umin.ac.jp/. ID. UMIN000012043).

Keywords: Anticholinergics; Bronchodilation; Pulmonary function tests; Three-dimensional computed tomography; β2 agonists.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adrenergic beta-Agonists / therapeutic use
  • Aged
  • Aged, 80 and over
  • Bronchi / diagnostic imaging*
  • Bronchi / drug effects
  • Bronchi / physiopathology
  • Bronchodilator Agents / pharmacology
  • Drug Therapy, Combination / methods
  • Female
  • Forced Expiratory Volume / drug effects
  • Glycopyrrolate / administration & dosage*
  • Glycopyrrolate / pharmacology
  • Humans
  • Indans / administration & dosage*
  • Indans / pharmacology
  • Japan / epidemiology
  • Lung / diagnostic imaging*
  • Lung / drug effects
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Muscarinic Antagonists / therapeutic use
  • Pulmonary Disease, Chronic Obstructive / diagnostic imaging*
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Quinolones / administration & dosage*
  • Quinolones / pharmacology
  • Respiratory Function Tests
  • Tomography, X-Ray Computed / methods*

Substances

  • Adrenergic beta-Agonists
  • Bronchodilator Agents
  • Indans
  • Muscarinic Antagonists
  • Quinolones
  • indacaterol
  • Glycopyrrolate