Two 1-year studies evaluated the long-term efficacy and safety of tiotropium 5 or 10 microg versus placebo, inhaled via the Respimat Soft Mist Inhaler (SMI). The two studies were combined and had 4 co-primary endpoints (trough FEV(1) response, Mahler Transition Dyspnea Index [TDI] and St George's Respiratory Questionnaire scores all at week 48, and COPD exacerbations per patient-year). A total ...

Over the past decade, several large-scale clinical trials have been performed to assess the impact of pharmacological treatments on patient-centred outcomes such as dyspnoea, exercise tolerance, exacerbations and health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). Tiotropium, a once-daily inhaled anticholinergic agent that works through prolonge...

INTRODUCTION Adherence to long-acting bronchodilator therapy for management of chronic obstructive pulmonary disease (COPD) is a critical clinical and cost issue. Low adherence is associated with relatively higher exacerbation rates and illness burden. PURPOSE To compare adherence between patients with COPD initiating therapy on tiotropium or fluticasone/salmeterol and examine the association...

www.thelancet.com/respiratory Vol 3 May 2015 333 inhaled corticosteroids, such as leukotriene inhibitors or slow-release theophylline? A small study showed that add-on montelukast to low-dose budesonide was better than add-on tiotropium in terms of control of asthma and FEV1. Further studies are needed. Addition of tiotropium to combined inhaled corticosteroids and LABA could also be an alterna...

BACKGROUND This study was conducted to confirm the 24-hour bronchodilator efficacy and pharmacokinetic profile of once-daily tiotropium Respimat® 5 μg add-on to inhaled corticosteroids (ICS) in adults with symptomatic asthma. It used a trial protocol designed to minimize the risk of pharmacokinetic sample contamination resulting from improper sampling procedure, sample handling, or device handl...

BACKGROUND The cost-effectiveness of umeclidinium bromide-vilanterol (UMEC/VI) versus tiotropium monotherapy in the UK was assessed using a UMEC/VI treatment-specific economic model based on a chronic obstructive pulmonary disease (COPD) disease-progression model. METHODS The model was implemented as a linked-equation model to estimate COPD progression and associated health service costs, and...

Patients with stable chronic obstructive pulmonary disease (COPD) and diurnal PaO2 > 60 mmHg may have transient oxygen desaturation during sleep. The effect of bronchodilators on nocturnal hypoxemia is not known. The aim of this study was to evaluate if a single dose of Formoterol or Tiotropium, administered in the evening, could improve nocturnal hypoxemia in patients with stable middle/severe...

Asthma management guidelines emphasize the importance of effective treatment to achieve and maintain control of asthma. However, despite widely available and effective treatments, achieving control of asthma is still an unmet need for many patients. Adding a second bronchodilator with a different mechanism of action for the treatment of uncontrolled asthma can be a suitable therapeutic approach...

The editorial by Jenkins and Beasley makes a speculative recommendation that tiotropium Respimat should not be prescribed in the treatment of chronic obstructive pulmonary disease (COPD), being primarily based on meta-analysis where mortality was not the primary end point. The meta-analysis by Singh et al reported that treating 124 patients per annum with tiotropium Respimat 5 ug resulted in on...

Tiotropium is a long-acting muscarinic antagonist (LAMA) that exerts its bronchodilatory effect by blocking endogenous acetylcholine receptors in the airways. Its safety and efficacy are well established for the treatment of COPD, and it is now being recognized for its role in improving lung function and control in asthma. This review discusses the evolving role of tiotropium delivered by the R...