12-week Treatment With Inhaled Tiotropium (18 mcg Once Daily) on Lung Function and Static Lung Volumes in Stable, Moderate to Severe Chronic Obstructive Pulmonary Disease (COPD) Patients. Correlation to Dyspnoea Scales

Inclusion criteria

• Male or female patients 40 years of age or older.
• All patients had to have a diagnosis of COPD and had to meet the following spirometric and static lung volume criteria:

• Patients had to have relatively stable, moderate to severe airway obstruction with:

• FEV1 ≤ 50 % of predicted value,
• FEV1/SVC ≤ 70 %.
• All patients had to have the presence of lung hyperinflation as demonstrated by RV ≥ 125 % of predicted value.

Predicted normal values were calculated according to European Community Coal and Steel (ECCS)

Males:

• FEV1 predicted (L) = 4.30 x height (metres) - 0.029 x age (years) - 2.49
• RV predicted (L) = 1.31 x height (metres) + 0.022 x age (years) - 1.23

Females:

• FEV1 predicted (L) = 3.95 x height (metres) - 0.025 x age (years) - 2.60
• RV predicted (L) = 1.81 x height (metres) - 0.016 x age (years) - 2.00
• Patients had to be current or ex-smokers with a smoking history of more than 10 pack-years (p.y.). Patients who never smoked cigarettes were excluded.

Number of p.y. = Number of cigarettes/day / 20 x years of smoking

• Patients had to be able to perform all study related tests including the SWT, acceptable pulmonary function tests including PEFR measurements, and had to be able to maintain records during the study period as required in the protocol.
• Patients had to be able to inhale medication from the HandiHaler.
• All patients had to sign an informed consent form prior to participation in the trial i.e. prior to pre-study washout of their usual pulmonary medication.
• Eosinophilia < 600/mm³ documented in the past year (if not available, a blood count cell was performed).

Exclusion criteria

• Patients with a history of asthma, allergic rhinitis or atopy.
• Patients with significant diseases other than COPD were excluded. A significant disease was defined as a disease which in the opinion of the investigator may have either put the patient at risk because of participation in the study or a disease which may have influenced the results of the study or the patient's ability to participate in the study.
• Patients with a recent history (i.e. one year or less) of myocardial infarction.
• Patients with a recent history (i.e. three years or less) of heart failure, pulmonary oedema, or patients with cardiac arrhythmia requiring drug therapy.
• Patients who regularly used daytime oxygen therapy for more than one hour per day and in the investigator.s opinion was unable to abstain from the use of oxygen therapy.
• Patients with known active tuberculosis.
• Patients with a history of cancer within the last five years. Patients with treated basal cell carcinoma were allowed.
• Patients with a history of life-threatening pulmonary obstruction, or a history of cystic fibrosis or bronchiectasis.
• Patients who underwent thoracotomy with pulmonary resection. Patients with a history of thoracotomy for other reason were evaluated as per exclusion criterion No. 2.
• Patients with lower respiratory tract infection in the past six weeks prior to the Screening Visit (Visit 1) or during the run-in period.
• Patients who were currently in a pulmonary rehabilitation programme or who completed a pulmonary rehabilitation programme in the six weeks prior to the Screening Visit (Visit 1).
• Patients with known hypersensitivity to anticholinergic drugs, lactose or any other components of the inhalation capsule delivery system.
• Patients with known symptomatic prostatic hypertrophy or bladder neck obstruction.
• Patients with known narrow-angle glaucoma.
• Patients who were treated with β-blockers, cromolyn sodium or nedocromil.
• Patients who were treated with antihistamines (H1 receptor antagonists) or antileukotrienes.
• Patients who were treated with monoamine oxidase inhibitors or tricyclic antidepressants.
• Patients using oral corticosteroid medication at unstable doses (i.e. less than six weeks on a stable dose) or at a dose in excess of the equivalent of 10 mg of prednisone per day or 20 mg every other day.
• Pregnant or nursing women or women of childbearing potential not using a medically approved means of contraception (i.e. oral contraceptives, intra-uterine devices, diaphragm or subdermal implants).
• Patients with history and/or active significant alcohol or drug abuse.
• Patients who took another investigational drug within one month or ten half lives (whichever was greater) prior to Visit 1.