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In the recently completed TORCH trial (Journal Watch Feb 21 2007), researchers did not include tiotropium (Spiriva) among the inhaled therapies that were compared in patients with chronic obstructive pulmonary disease. Now, investigators report results from the international, randomized INSPIRE trial, in which tiotropium was compared with salmeterol/fluticasone (Advair). The study, which was supported by the manufacturer of the latter drug, involved 1323 patients with severe COPD who received inhaled salmeterol/fluticasone (50/500 µg twice daily) or inhaled tiotropium (18 µg once daily), in addition to corresponding placebo inhalers.
During the trial, more patients in the tiotropium group than in the salmeterol/fluticasone group withdrew. At…