Effect of Inhaled Tiotropium as the Perioperative Management of Patients Undergoing Pulmonary Resection for Primary Lung Cancer: Critical Study

Takanori Ayabe; Masaki Tomita; Eiichi Chosa; Katsuya Kawagoe; Kunihide Nakamura

Takanori Ayabe Division of Thoracic and Breast Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Masaki Tomita Division of Thoracic and Breast Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Eiichi Chosa Division of Thoracic and Breast Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Katsuya Kawagoe Division of Thoracic and Breast Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Kunihide Nakamura Division of Thoracic and Breast Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.

Keywords: Tiotropium, pulmonary function, lung age, lobectomy, lung cancer

Abstract

Background: The purpose of this study was to evaluate the effectiveness of perioperative tiotropium therapy for patients undergoing pulmonary resection for primary lung cancer. The short-term tiotropium effect was investigated by perioperative pulmonary function and lung age.

Methods: The fifty-five patients who underwent a lobectomy and had tiotropium treatment available from October 2007 through May 2009 were the subjects. The patients were divided into 3 groups according to their airway limitation such as Chronic Obstructive Pulmonary Disease (COPD) or a history of smoking; those with COPD (%FEV₁ ? 70%, C-group, n = 22), smokers (%FEV₁ > 70%, S-group, n = 10) and non-smokers (%FEV₁ > 70%, N-group, n = 23). As the bronchodilator groups, the C- and S-groups received inhaled tiotropium bromide (18 ?g once daily) for 1 week before surgery until at least 3 weeks after surgery without interruption, and as a control, the N-group had no treatment. The preoperative baselines, the predicted postoperative values, and the actual postoperative ones were measured by the pulmonary function test. The changed rates were calculated and denoted as ?VC, ?FEV₁, ?VC% and ?FEV₁/FVC, from the baseline of the predicted postoperative values. The mean real age and lung age were calculated.

Results: In the S-group, the parameters of ?VC, ?FEV₁, ?VC% and ?FEV₁/FVC significantly increased compared to those of the N-group. In the C-group, the increased extents of ?FEV₁ and FEV₁/FVC were lower compared to those in the S-group (not significant). In the N-group, the parameters of ?VC, ?FEV₁, and ?VC% decreased. The postoperative lung age and real age were increased to 29.5 18.0 year-old in the C-group, 25.8 18.0 in the S -group, and 24.7 17.0 in the N-group. Lung resection affected the lung age; the aging was a 28.9 12.7 year-old increase in the N-group. In the C- and S-group, the lung age was a 14-year-old increase. The effect of tiotropium treatment affected the lung age as a 15-year-old increase.

Conclusion: Perioperative interventional tiotropium contributed to the lobectomy patients with COPD and for smokers with a non-obstructive airway and played a role of preserving the postoperative lung function.