In 2001, we concluded that patients with symptoms of stable chronic obstructive pulmonary disease (COPD) inadequately controlled by an 'as-required' inhaled short-acting beta2 agonist can be helped by regular use of an inhaled antimuscarinic bronchodilator or a long-acting beta2 agonist.1 Since then, a new antimuscarinic drug ▼tiotropium bromide (Spiriva - Pfizer/Boehringer Ingelheim) has been licensed as a once-daily bronchodilator for maintenance treatment of COPD in people aged 18 years or over. Here, we review the evidence for efficacy of tiotropium and discuss its role in the maintenance treatment of COPD.
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