Review: tiotropium reduces exacerbations and hospitalizations in COPD and improves quality of life.

M e t h o d s Data sources: The Cochrane Airways Review Group Specialized Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE/Excerpta Medica, CINAHL, LILACS (to October 2004); hand-searching 20 respiratory journals, conference abstracts, and bibliographies of relevant studies; and contacting authors. Study selection and assessment: Randomized controlled trials (RCTs) in any language that included patients > 35 years of age with known stable COPD without evidence of an exacerbation for 1 month before study entry, and compared tiotropium with placebo, ipratropium bromide, or long-acting β-agonists (salmeterol or formoterol) for ≥ 1 month. Studies of patients with diseases other than COPD, previous asthma, cystic fibrosis, bronchiectasis, or other lung diseases were excluded. Study quality was assessed using Cochrane criteria for allocation concealment and the 5-point Jadad scale. Outcomes: Exacerbations (respiratory symptoms lasting ≥ 3 d), hospitalizations for exacerbations, and all-cause mortality. Secondary outcomes included health-related quality of life assessed using the St. George’s Respiratory Questionnaire (SGRQ) and the Transitional Dyspnea Index (TDI), change in FEV1, change in FVC, and adverse events.