+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Tiotropium bromide, a new, once-daily inhaled anticholinergic bronchodilator for chronic-obstructive pulmonary disease



Tiotropium bromide, a new, once-daily inhaled anticholinergic bronchodilator for chronic-obstructive pulmonary disease



Expert Opinion on PharmacoTherapy 5(8): 1827-1835



Tiotropium bromide is a quaternary ammonium compound structurally related to ipratropium and has recently been approved in the US for the long-term, once-daily, maintenance treatment of bronchospasm associated with chronic-obstructive pulmonary disease (COPD). It is available in a dry powder form, where 18 microg [corrected] of the drug is inhaled once-daily through a device, the HandiHaler). The potency and long duration of effect of this anticholinergic bronchodilator result primarily from a prolonged blockade of the M1 and M3 muscarinic receptors in the airways and a relatively more rapid dissociation from the M2 receptor (which provides inhibitory feedback). Multiple studies of up to a duration of 1 year have demonstrated its effectiveness as a bronchodilator for COPD, with a trough increase (measured approximately 24 h after administration of the drug) in forced expiratory volume in 1 s of approximately 0.12 l and a peak increase of approximately 0.25 l. Tiotropium inhalation also leads to a significant reduction in static lung volumes in hyperinflated patients with COPD; this probably contributes to the reduction in dyspnoea that is associated with long-term use of this maintenance bronchodilator. Regular use of the drug was associated with clinically meaningful increases in the Transitional Dyspnoea Index, which indicate reductions in dyspnoea associated with daily activities. Improvement in the respiratory-specific health status questionnaire, the St George's Respiratory Questionnaire component and total scores was also documented. Finally, pooled data from two 1-year studies and two 6-month studies documented 20 and 28% reductions in the number of exacerbations per patient per year. Side effects have been relatively minimal, with dry mouth the most common symptom, ranging 6 - 16% of patients and rarely leading to discontinuation of the study drug. Limited comparisons of efficacy with other bronchodilators are available. Once-daily tiotropium has been demonstrated to be clearly superior to ipratropium four times daily as a bronchodilator for COPD. Combined results from two studies comparing once-daily tiotropium to twice-daily inhalation of standard doses of salmeterol, indicate a magnitude of the bronchodilator response similar in the two drugs early in the study. However, by 6 months, the bronchodilator effect of tiotropium was somewhat greater than that of the long-acting beta-agonist. Preliminary data suggest that combining tiotropium with long-acting beta-agonists may produce additional bronchodilator action in COPD.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 050795622

Download citation: RISBibTeXText

PMID: 15264997

DOI: 10.1517/14656566.5.8.1827


Related references

Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease with Tiotropium, a Once-Daily Inhaled Anticholinergic Bronchodilator: A Randomized Trial. Yearbook of Pulmonary Disease 2007: 92-93, 2007

Prevention of exacerbations of chronic obstructive pulmonary disease with tiotropium, a once-daily inhaled anticholinergic bronchodilator: a randomized trial. Annals of Internal Medicine 143(5): 317-326, 2005

Tiotropium bromide: a long-acting anticholinergic bronchodilator for the treatment of patients with chronic obstructive pulmonary disease. International Journal of Clinical Practice 57(10): 906-909, 2003

Tiotropium (Spiriva): a once-daily inhaled anticholinergic medication for chronic obstructive pulmonary disease. Proceedings 17(3): 366-373, 2004

Tiotropium: an inhaled anticholinergic for chronic obstructive pulmonary disease. American Journal of Health-System Pharmacy 62(12): 1263-1269, 2005

Tiotropium: An inhaled anticholinergic for chronic obstructive pulmonary disease. American Journal of Health-System Pharmacy 62(12): 1263-1269, 2005

Tiotropium bromide: a new long-acting bronchodilator for the treatment of chronic obstructive pulmonary disease. Clinical Therapeutics 27(4): 377-392, 2005

Tiotropium: An inhaled, long-acting anticholinergic drug for chronic obstructive pulmonary disease. Pharmacotherapy 23(2): 183-189, 2003

Tiotropium (Spiriva) - a long-acting inhaled anticholinergic for the treatment of chronic obstructive pulmonary disease (COPD). Pneumologie 57(9): 519-525, 2003

Effect of a new anticholinergic bronchodilator aerosol, 8-isopropylscopolamine bromide, on chronic obstructive pulmonary disease. Zhonghua Jie he He Hu Xi Xi Ji Bing Za Zhi 7(1): 24-27, 1984

The effect of a new anticholinergic bronchodilator aerosol 8 isopropylscopolamine bromide in chronic obstructive pulmonary disease. Chinese Journal of Tuberculosis & Respiratory Diseases 7(1): 24-27, 63, 1984

Tiotropium bromide: a novel once-daily anticholinergic bronchodilator for the treatment of COPD. Drugs of Today 38(9): 585-600, 2002

UPLIFT Study: the effects of long-term therapy with inhaled tiotropium in chronic obstructive pulmonary disease. Evaluation of: Tashkin DP, Celli B, Senn S et al.: a 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med (2008) 359(15):1543-1554. Expert Opinion on PharmacoTherapy 10(4): 719-722, 2009

Inhaled Glucocorticoid with or without Tiotropium Bromide for Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome. Journal of the College of Physicians and Surgeons--Pakistan 29(3): 249-252, 2019

Comparison of the anticholinergic bronchodilator ipratropium bromide with metaproterenol in chronic obstructive pulmonary disease. A 90-day multi-center study. American Journal of Medicine 81(5a): 81-90, 1986