Tiotropium bromide is a novel, inhaled, once-daily
anticholinergic bronchodilator that has recently been approved in the United States for use in patients with
COPD. Its unique feature is the persistence of bronchodilation for > 24 h due to prolonged M(3)
muscarinic receptor blockade.
Tiotropium provides significant improvement in spirometry and lung volumes. Clinically relevant outcomes such as the relief of
dyspnea, improvement in the quality of life (health status), and reductions in the frequency and severity of acute exacerbations have been consistently obtained with
tiotropium in clinical trials. In head-to-head trials,
tiotropium administered once daily resulted in bronchodilation (peak, trough, and area under the curve) that was statistically superior to
ipratropium administered four times daily and
salmeterol administered twice daily. Clinical outcomes (
dyspnea, quality of life, exacerbation frequency) were numerically but not always statistically better with
tiotropium than
salmeterol. Long-term studies of the combination of
tiotropium with
adrenergic agents, methylxanthines, or inhaled
corticosteroids have not been reported in full. Several 1-year studies demonstrate that the only significant side effect of
tiotropium was dryness of the mouth, which occurred in approximately 10 to 16% of patients; it is well tolerated by patients and safe.