Exacerbations of chronic obstructive pulmonary disease (COPD) have a negative effect on the clinical course and outcome of the disease thus causing considerable social and economic burden. As the natural course of the disease may vary, the treatment should take into account an individual approach to a patient. The appropriate treatment makes it possible to control the symptoms, improves effort ...

Rationale In patients with symptomatic asthma receiving ICS or ICS +LABA, Phase III studies have demonstrated improved lung function with tiotropium Respimat®, a once-daily long-acting anticholinergic bronchodilator. The efficacy of some treatments (eg ICS and omalizumab), appears higher in TH2-high phenotypes, but no specific treatments are available that work equally well in both TH2-high and...

Adding tiotropium to standard combination therapy may help reduce exacerbations in some adults whose asthma is poorly controlled despite the use of inhaled glucocorticoids and long-acting beta-agonists, according to two randomized, controlled trials published in the New England Journal of Medicine. However, tiotropium use did not increase the number of symptom-free days or boost patients’ asthm...

OBJECTIVE To assess the cost-effectiveness of 3 treatments (tiotropium, salmeterol, and no treatment) in patients with moderate chronic obstructive pulmonary disease (COPD). METHODS A Markov model with a time horizon of 1 year was developed. A hypothetical cohort of 100,000 subjects with moderate COPD with mean age of 65 years, smoking history of 50 pack-years, and disease duration of 9.5 yea...

BACKGROUND Although combination therapy with bronchodilators is recommended for chronic obstructive pulmonary disease (COPD), there is insufficient evidence for the efficacy of some combinations of long-acting bronchodilators. OBJECTIVE We investigated the effects of a combination therapy with tiotropium and theophylline in COPD patients. METHODS In a 12-week, open-labeled, parallel-group r...

Bronchodilators play an important role in the treatment of chronic obstructive pulmonary disease (COPD) and anticholinergics have a long history as an effective and safe treatment. Two papers in this issue extend the information available on tiotropium, through large studies lasting a year. The study by VINCKEN et al. [1], on behalf of the Dutch/Belgian tiotropium study group, shows better resu...

Tiotropium bromide is a once-daily inhaled anticholinergic bronchodilator. It works by blocking the muscarinic receptors in airway smooth muscle. Tiotropium has a wide therapeutic margin, due to its poor gastrointestinal absorption and its very low systemic bioavailability. The drug is mainly indicated in COPD patients. Clinically relevant outcomes such as significant improvements in spirometry...

Background: In chronic obstructive pulmonary disease (COPD), the degree of circadian variation in forced expiratory volume in 1 second (FEV1) and the influence of anticholinergic blockade is not known. Tiotropium is a long acting inhaled anticholinergic bronchodilator that increases daytime FEV1 in COPD. We hypothesised that tiotropium would modify the overnight change in FEV1, and this would b...