The Effects of Tiotropium on the Cough Reflex in Patients With Chronic Obstructive Pulmonary Disease (COPD)
The Effects of Tiotropium on the Cough Reflex in Patients With Chronic Obstructive Pulmonary Disease (COPD)
Does tiotropium effect the cough reflex in patients with COPD and chronic bronchitis.
Cough Questionnaire

 This questionnaire is designed to assess the impact of cough on various aspects of your life.
 Read each question carefully and answer by CIRCLING the response that best applies to you.
 Please answer ALL questions, as honestly as you can.

 1. In the last 2 weeks, have you had chest or stomach pains as a result of your cough? 1 2
 3 4 5 6 7 All of the time Most of the time A good bit of time Some time A little of the
 time Hardly any time None of the time

 2. In the last 2 weeks, have you been bothered by sputum (phlegm) production when you
 cough? 1 2 3 4 5 6 7 All of the time Most of the time A good bit of time Some time A
 little of the time Hardly any time None of the time

 3. In the last 2 weeks, have you been tired because of your cough? 1 2 3 4 5 6 7 All of the
 time Most of the time A good bit of time Some time A little of the time Hardly any time
 None of the time

 4. In the last 2 weeks, have you felt in control of your cough? 1 2 3 4 5 6 7 None of the
 time Hardly any time A little of the time Some time A good bit of time Most of the time
 All of the time

 5. How often during the last 2 weeks have you felt embarrassed by your coughing? 1 2 3 4 5
 6 7 All of the time Most of the time A good bit of time Some time A little of the time
 Hardly any time None of the time

 6. In the last 2 weeks, my cough has made me feel anxious 1 2 3 4 5 6 7 All of the time
 Most of the time A good bit of time Some time A little of the time Hardly any time None
 of the time

 7. In the last 2 weeks, my cough has interfered with my job, or other daily tasks 1 2 3 4 5
 6 7 All of the time Most of the time A good bit of time Some time A little of the time
 Hardly any time None of the time

 8. In the last 2 weeks, I felt that my cough interfered with the overall enjoyment of my
 life 1 2 3 4 5 6 7 All of the time Most of the time A good bit of time Some time A
 little of the time Hardly any time None of the time

 9. In the last 2 weeks, exposure to paints or fumes has made me cough 1 2 3 4 5 6 7 All of
 the time Most of the time A good bit of time Some time A little of the time Hardly any
 time None of the time

 10. In the last 2 weeks, has your cough disturbed your sleep? 1 2 3 4 5 6 7 All of the time
 Most of the time A good bit of time Some time A little of the time Hardly any time None
 of the time
Inclusion Criteria:

 After signing the informed consent, screening testing will be done to document that a
 subject meets the requirements of the study. Specific inclusion criteria are:

 -  Subjects between the ages of 40 and 80 years of age (Dates of Birth 1925-1965)

 -  Current smoker (with smoking history of > 10 pack/year) or ex-smoker (stopped within 1
 year and has at least a 10 pack/year smoking history).

 -  Subjects will be included if they meet criteria for mild and moderate COPD as defined
 by the American Thoracic Society and European Respiratory Society position paper. Mild
 COPD will be defined as a postbronchodilator (2 puffs of albuterol) FEV1/FVC ratio of
 <0.7 and a predicted FEV1 of > 80%. Moderate COPD will be defined as a
 postbronchodilator FEV1/FVC ratio of <0.7 and a predicted FEV1 50-80%. A response to
 bronchodilators is defined as an increase of 12% or 200cc in FEV1 from baseline after
 inhalation of 2 puffs of albuterol. Both subjects with and without a response to
 bronchodilators will be included in the study.

 -  All subjects will be clinically stable for 4 weeks prior to inclusion. Clinical
 stability is defined as having no recent COPD exacerbations within the last 4 weeks
 and having received no antibiotics or change in their inhaled steroid dose during that
 time period. If a subject is on oral steroids, they will be required to be on 10 mg or
 less each day or no more than 20mg every other day to be eligible. If the oral steroid
 dose has been titrated over the previous 4 weeks (either up or down) or if the dose is
 higher than what has been described previously, they will be ineligible for the study.

 -  All subjects will be off of tiotropium or ipratropium for 1 month prior to the start
 of the study.

 -  Chronic cough: Chronic cough will be characterized by the presence of a productive
 cough for 3 months in each of 2 successive years in persons in whom other causes of
 chronic cough have been excluded.

 Exclusion Criteria:Exclusion Criteria: Subjects will not be eligible for the study if they
 are

 -  Age of < 40 or > 80 years.

 -  Refusal to volunteer for the study and not willing to sign the informed consent form.

 -  Respiratory disorder other than COPD including asthma, chronic bronchiectasis or
 pulmonary fibrosis

 -  Oxygen or ventilator dependent COPD.

 -  Received any antibiotics or had a change in their inhaled steroid dose during the last
 4 weeks. If a subject is on oral steroids, they will be required to be on 10 mg or
 less each day or no more than 20mg every other day to be eligible. If the oral steroid
 dose has been titrated over the previous 4 weeks (either up or down) or if the dose is
 higher than what has been described previously, they will be ineligible for the study.

 -  History of Congestive heart failure, cardiomyopathy, valvular heart disease, angina,
 cardiac arrhythmia, or myocardial infarction within the last 6 months or poorly
 controlled hypertension.

 -  History of chronic hepatitis or hepatic cirrhosis.

 -  End-stage renal disease.

 -  History of neurologic or psychiatric disorder which would interfere with completion of
 the study.

 -  Physician diagnosis of Gastroesophageal reflux disease

 -  Physician diagnosis of allergic, non-allergic rhinitis, or sinusitis

 -  History of lung cancer

 -  History of radiation treatment to the chest or mediastinum

 -  Lung volume reduction surgery, segmentectomy, lobectomy or pneumonectomy

 -  History of a thoracotomy

 -  Symptomatic Benign prosthetic hypertrophy

 -  Symptomatic bladder outlet obstruction

 -  Symptomatic glaucoma

 -  Severe COPD defined as a postbronchodilator FEV1/FVC ratio of < 0.7 and a predicted
 FEV1 of 30-50%. Very severe COPD defined as a postbronchodilator FEV1/FVC ratio of
 <0.7 and a predicted FEV1 of < 30%. (Eur Respir J 2004; 23: 932-946).

 -  Within the previous one month (30 days) prior to beginning the study, used or continue
 to use ipratropium or tiotropium

 -  Allergic response or history of allergy to lactose