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

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%, Sgroup,
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 μg 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 ΔVC, ΔFEV1, ΔVC% and ΔFEV1/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 ΔVC, ΔFEV1, ΔVC% and ΔFEV1/FVC significantly
increased compared to those of the N-group. In the C-group, the increased extents of ΔFEV1 and
FEV1/FVC were lower compared to those in the S-group (not significant). In the N-group, the
parameters of ΔVC, ΔFEV1, and ΔVC% 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.