Tiotropium Attenuates Symptoms in Moderate COPD but Does Not Slow Progression

In a manufacturer-sponsored trial, reported in 2008, the long-acting inhaled anticholinergic drug tiotropium (Spiriva) increased pre- and postbronchodilator FEV₁ values in patients with moderate-to-severe chronic obstructive pulmonary disease during 4 years of follow-up but failed to slow the rate of FEV₁ decline (JW Gen Med Oct 16 2008). The authors now report the effects of tiotropium in a subgroup of patients with only moderate COPD.

Of 5993 patients in the original trial, 2739 had moderate COPD (baseline postbronchodilator FEV₁, 50%–70% of predicted). Patients were randomized to once-daily inhaled tiotropium or placebo; most also used inhaled corticosteroids, long-acting β₂-agonists, or both, as permitted by the study design. Compared wi…