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

• Published in: Respiratory medicine Vol. 119; pp. 70 - 77
• Main Authors: Shimizu, Kaoruko, Seto, Ruriko, Makita, Hironi, Suzuki, Masaru, Konno, Satoshi, Ito, Yoichi M, Kanda, Rie, Ogawa, Emiko, Nakano, Yasutaka, Nishimura, Masaharu
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2016; Elsevier Limited
• Subjects: Administration, Inhalation; Adrenergic beta-Agonists - therapeutic use; Aged; Aged, 80 and over; Anticholinergics; Bronchi - diagnostic imaging; Bronchi - drug effects; Bronchi - physiopathology; Bronchodilation; Bronchodilator Agents - pharmacology; Carbon monoxide; Chronic obstructive pulmonary disease; Colleges & universities; Drug Therapy, Combination - methods; Female; Forced Expiratory Volume - drug effects; Glycopyrrolate - administration & dosage; Glycopyrrolate - pharmacology; Hospitals; Humans; Indans - administration & dosage; Indans - pharmacology; Japan - epidemiology; Lung - diagnostic imaging; Lung - drug effects; Lung - physiopathology; Male; Medical imaging; Middle Aged; Muscarinic Antagonists - therapeutic use; Proprietary; Pulmonary Disease, Chronic Obstructive - diagnostic imaging; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary function tests; Pulmonary/Respiratory; Quinolones - administration & dosage; Quinolones - pharmacology; Respiratory Function Tests; Science; Sensors; Software; Three-dimensional computed tomography; Tomography, X-Ray Computed - methods; β2 agonists; short acting muscarinic antagonist; RV; SAMA; forced vital capacity; Ai; diffusing capacity of the lung for carbon monoxide; TLC; functional residual capacity; salmeterol/fluticasone combination inhaler; airway inner luminal area; β2 agonists; Anticholinergics; SFC; vital capacity; LABA; IC; short acting β2 agonist; Pi10; BMI; Bronchodilation; computed tomography; residual volume; 3D-CT; DL co; body mass index; forced expiratory volume in 1 s; alveolar volume; Pulmonary function tests; LAMA; SABA; VC; CT; long acting muscarinic antagonist; FVC; three-dimensional CT; Three-dimensional computed tomography; total lung capacity; FRC; V A; inspiratory capacity; FEV1; the square root of the airway wall area at an internal perimeter of 10 mm; COPD; chronic obstructive pulmonary disease; long acting β2 agonist; DLco; VA
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2016.08.020

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).