Tiotropium bromide, an inhaled long-acting anticholinergic available since 2004 as a dry powder inhaler (Spiriva Handihaler) for once-daily treatment of chronic obstructive pulmonary disease (COPD),1 has now also been approved in an inhalation spray formulation (Spiriva Respimat – Boehringer Ingelheim). According to the manufacturer, the Respimat device improves delivery of tiotropium to the lungs because, unlike with the Handihaler, it is not dependent on the strength of the patient's breath intake.

MAINTENANCE TREATMENT – In patients with moderate to severe COPD, regular treatment with an inhaled long-acting bronchodilator (an anticholinergic or a beta₂-agonist) can relieve symptoms, improve lung function, and reduce the frequency of exacerbations. A combination of an anticholinergic and a beta₂-agonist can be used for ... more      

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