Tiotropium bromide: a new long-acting bronchodilator for the treatment of chronic obstructive pulmonary disease.

BACKGROUND: Tiotropium bromide is a new inhaled anticholinergic agent approved for once-daily, long-term maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD). OBJECTIVE: This article reviews the pharmacology, pharmacokinetic and pharmacodynamic properties, clinical efficacy, tolerability, and cost of tiotropium therapy in patients with COPD. METHODS: The MEDLINE (1966-October 2004), Iowa Drug Information Service (1966-October 2004), and International Pharmaceutical Abstracts (1970-November 2004) databases were searched for original research and review articles published in English. The search terms were tiotropium, Ba 679 BR, and HandiHaler. Reference lists from these articles were also consulted, as was selected information provided by the manufacturer of tiotropium. All relevant identified studies were included in the review, with preference given to Phase II/III trials. Pharmacoeconomic studies were limited to those conducted in the United States. RESULTS: Tiotropium is a nonselective anticholinergic agent that exhibits kinetic receptor selectivity for the muscarinic M1 and M3 receptors. After inhalation, tiotropium has an onset of action within 30 minutes, a peak effect within 3 to 4 hours, and a > or = 24-hour duration of action that allows once-daily dosing. In clinical trials, patients receiving tiotropium 18 microg QD had significant improvements in trough, peak, and mean forced expiratory volume in 1 second (FEV1), dyspnea, and health-related quality of life, as well as fewer COPD exacerbations and hospitalizations, compared with patients receiving placebo and ipratropium (all, P < 0.05). Improvement in FEV1 was also significantly greater in patients who received tiotropium compared with those who received salmeterol (P < 0.05), although the number of exacerbations and extent of health resource use were comparable between groups. Dry mouth was the most commonly reported adverse effect. One analysis found tiotropium to be cost-effective compared with ipratropium. CONCLUSIONS: Tiotropium offers several advantages over ipratropium in the management of COPD. Long-term (> 1 year) studies are necessary to determine the impact of tiotropium on disease progression and life expectancy.

Current status of pharmacist-operated drug information centers in the United States.

PURPOSE: Pharmacist-operated drug information centers (DICs) in the United States and Puerto Rico were surveyed, and the results were compared with those of similar surveys conducted over the past 30 years. METHODS: In January 2003, surveys were mailed to 151 institutions that were thought to have an organized DIC, defined as a center that regularly accepts a broad scope of requests from health care professionals, regardless of the location or affiliation of those professionals. The survey covered such topics as affiliations, staffing, services, resources, quality assurance, involvement in education, and funding. RESULTS: One hundred nineteen DICs responded (79%), of which 81 met the criteria. Hospitals and medical centers and colleges and schools of pharmacy continued to be the most commonly reported affiliations. The number of DICs declined in the past decade, and the number of DIC pharmacists and other personnel was the lowest reported in the past 30 years. Drug information pharmacists appeared to be better trained than in the past, and a larger percentage had advanced degrees. Services provided by DICs remained consistent with previous findings, except for greater participation in the training and education of pharmacy students and residents. The resource most commonly reported by DICs as useful was Micromedex Healthcare Series, followed by MEDLINE and AHFS Drug Information. The percentage of DICs with formal quality assurance programs did not change significantly in the past decade. Funding sources and fee-for-service activities remained the same. CONCLUSION: The number of DICs has declined steadily since 1986, and the number of drug information pharmacists is at its lowest in 30 years. DIC services continue to be comprehensive. Only half of the DICs surveyed had a formal quality assurance program.

Availability of and attitudes toward resources on alternative medicine products in the community pharmacy setting.

OBJECTIVE: To examine the availability of resources on dietary supplements in the community pharmacy setting and to assess the attitudes of community pharmacists toward these resources. DESIGN: Cross-sectional study. SETTING: Community pharmacies in New York and New Jersey that serve as experiential sites for senior student pharmacists at the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University. PARTICIPANTS: Preceptors or full-time pharmacists. INTERVENTION: Mailed survey. MAIN OUTCOME MEASURES: Frequency of use, availability of, and pharmacists' satisfaction with resources on alternative medicines, defined in the survey as any product including herbal remedies, vitamins, minerals, and natural products that may be purchased at a health food store, pharmacy, supermarket, alternative medicine store/magazine for the purpose of self-treatment. RESULTS: A total of 64 pharmacists characterized their frequency of use of resources on alternative medicines while formulating responses to questions as: never (n = 5; 7.8%), seldom (n = 31; 48.4%), often (n = 24; 37.5%), or always (n = 4; 6.3%). A total of 30 different resources were available to 40 respondents. The most commonly available resources were the PDR for Herbal Medicines (42.5%), The Review of Natural Products (20.0%), and the Web site of the National Center for Complementary and Alternative Medicine (12.5%). Of 54 respondents, 4 (7.1%) reported being completely dissatisfied with the available resources; 17 (31.5%) were somewhat dissatisfied; 25 (46.3%) were somewhat satisfied; and 8 (14.8%) were completely satisfied with the resources available to them. Topics the pharmacists most commonly wanted to see improved included safety (72.7%), interactions (70.9%), and uses (69.1%). CONCLUSION: Community pharmacists do not use information resources on alternative medicine products frequently, and many are not satisfied with the resources available to them.