Assessing the Impact of Tiotropium on Lung Function and Physical Activity in GOLD Stage II COPD Patients who are Naïve to Maintenance Respiratory Therapy: A Study Protocol

Thierry Troosters*, 1 , Idelle Weisman 2, Fabienne Dobbels 3, Nicholas Giardino 4, Srinivas Rao Valluri 5
1 Pulmonary Rehabilitation and Respiratory Division, UZ Gasthuisberg, Leuven, Belgium, and Department of Rehabilitation Sciences, KU-Leuven, Belgium
2 Medical Affairs-Respiratory, Primary Care Business Unit, Pfizer, Inc., New York, NY, USA
3 Center for Health Services and Nursing Research, KU-Leuven, Leuven, Belgium
4 Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI USA
5 Statistics, Specialty Care Business Unit, Pfizer, Inc., New York, NY, USA

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© Troosters et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Pulmonary Rehabilitation and Respiratory Division, UZ Gasthuisberg, Leuven, Belgium; Tel: + 32 16 34 71 07; Fax: + 32 16 34 71 26; E-mail:


Physical activity status is increasingly recognized as a reliable predictor of mortality and hospitalization in patients with chronic obstructive pulmonary disease (COPD). The reduction in physical activity occurs earlier in the clinical course of COPD than previously appreciated, possibly arising from breathlessness, reduced exercise tolerance, and adoption of a more sedentary lifestyle. To date, no clinical trial has evaluated the impact of pharmacotherapy on both lung function and physical activity. We recently designed a study that evaluates the impact of tiotropium (a once-daily inhaled anticholinergic) on lung function and physical activity in a maintenance/treatment-naïve Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stage II COPD cohort. Previous studies have demonstrated that tiotropium improves lung function and exercise tolerance; whether these benefits translate into improvements in physical activity is the focus of the current work. Here we describe the rationale and challenges in developing and implementing this study and review its unique features and novel design, including: utility of direct activity monitoring in multicenter clinical trials; importance of behavioral-modification techniques (including motivational interviewing to improve patient self-efficacy and adherence for a healthy, more active lifestyle); utility of individualized activity plans that provide an integrated approach with pharmacotherapy and behavioral modification to help patients achieve a more active lifestyle.

Keywords: COPD, physical activity, activity monitor, tiotropium, methodology, study design..