Lung Function and Health Status in Patients of Chronic Obstructive Pulmonary Disease on Treatment with Tiotropium

Introduction: Chronic obstructive pulmonary disease (COPD) is a group of chronic and slowly progressive respiratory disordercharacterized by reduced maximum expiratory flow during forced exhalation. Tiotropium, a long-acting antimuscarinic agent,has well-known documented effect on improving lung function and quality of life (QOL). There are many studies globally ontiotropium and its effect on lung function, but limited studies available in our Indian set up. Hence, we planned this study.Materials and Methods: Patients were recruited from chest clinic and outpatient department from the Department of Medicineof University College of Medical Sciences and GTB Hospital. It was a prospective observational cohort study conducted fromNovember 2017 to April 2019. Tiotropium was given as meter dose inhaler in dose of 18 µg per dose, in schedule as prescribedby the Global Initiative for Chronic Obstructive Lung Disease-2017 guidelines. Patients were followed up for 3 months withperiodic assessment of lung functions, Saint George’s Respiratory Questionnaire (SGRQ) score, and symptoms assessment.Results: A total of 65 patients were recruited for study which included 57 (87.7%) males and 8 (12.3%) females. Among thepulmonary function tests measured, there is a significant change in mean forced expiratory volume (FEV1) at the end of followup period compared to FEV1 at baseline. There is a significant change in mean forced vital capacity at the end of follow-upstudy compared to start of the study. There was no significant change in mean SGRQ score after 1 month of start of drug,but significant statistical change observed at end of the 3rd month of the study compared to the 1st month that implies SGRQscore decreased and patients health status and QOL improved. There is a significant change in mean SGRQ score at the endof follow-up study compared to baseline. In our study, 16 patients (24.6%) complained of dry mouth, 7 (10.7%) complained ofpharyngitis or throat irritation, and 3 (4.6%) patients complained of constipation.Conclusion: There was a statistically significant change in lung functions and improvement in QOL scores as assessed bySGRQ at the end of the study compared to baseline by use of inhaled tiotropium in COPD patients

Characteristics of urinary retention in female inpatients managed with medical treatments

PURPOSE: We aimed to analyze the characteristics of urinary retention (UR) in female inpatients managed with medical treatments. MATERIALS AND METHODS: We retrospectively analyzed the medical records of female inpatients referred to the department of urology for UR at our institution from January 2009, to December 2014. UR was defined as a difficulty in self-voiding despite a sufficient urine volume or >300-mL postvoid residual. The data included patients' age, body mass index (BMI), ambulatory status, medical and surgical history, classes of taking drugs, and urinary tract infection. RESULTS: A total of 182 women were included as retention group, mean age of 72.64±12.94 years and BMI of 22.94±3.10 kg/m2. In the chi-square analysis, cardiovascular disorders (p=0.000), diabetes mellitus (p=0.008), metastatic malignancy (p=0.008), chronic renal disorders (p=0.028) were found significantly. In the multiple logistic regression analysis, cardiovascular disorders (p=0.002; odds ratio [OR], 0.491), metastatic malignancy (p=0.013; OR, 2.616) were found to increase the risk of UR. The most common surgical history was anti-incontinence surgery (7.2%). In term of medication use, the most prescribed agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (53.8%). The patients taking multiple drugs with antimuscarinic effects except of NSAIDs, narcotics and diuretics were 48 (26.4%). Urinary tract infection was identified in 43 patients (23.6%). CONCLUSIONS: UR in females managed with medical treatments could be occurred occasionally. We think that thorough attentions are needed for UR to patients with cardiovascular disorders including diabetes mellitus, metastatic malignancy, chronic renal disorders urinary tract infection, and more careful interests when managing with drugs with antimuscarinic effects.

Predictors of Antimuscarinic Treatment Response for Female Patients with Overactive Bladder / 대한비뇨기과학회지

PURPOSE: To analyze the predictors of the antimuscarinic treatment response for female patients with an overactive bladder (OAB). MATERIALS AND METHODS: Eighty women diagnosed with an OAB, who had also undergone 3 months of treatment with propiverine hydrochloride (20mg/day), were enrolled. All patients were assessed by history taking, physical examination, urinalysis, frequency/volume charts and urodynamic study (UDS) prior to treatment; frequency/volume charts and a patients' satisfaction were analyzed 3 months after treatment. Patients were divided into satisfied, moderate and unsatisfied groups according to their subjective satisfaction. RESULTS: Subgroups according to the patients' subjective satisfaction included 57, 14 and 9 patients for satisfied, moderate and unsatisfied group, respectively. In the UDS, detrusor overactivity was noted in 15 patients of the satisfied group, 2 of the moderate group, but none of the unsatisfied group. Maximum detrusor pressure and detrusor pressure at maximum flow were higher in the unsatisfied group. The incidence of bladder outlet obstruction (BOO) was higher in the moderate and unsatisfied groups. In pre-treatment frequency/volume chart, the frequency of urge symptom was significantly increased in the satisfied group. Comparing the pre- and post-treatment frequency/volume charts revealed that the satisfied and moderate groups showed decreased frequency and nocturia, and increased functional bladder capacity compared to unsatisfied group after treatment. CONCLUSIONS: The efficacy of antimuscarinic treatment in female OAB could be associated with the frequency of urge symptom, detrusor overactivity and BOO; an UDS may aid in predicting the efficacy of antimuscarinic treatment.