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Abstract
Tiotropium (Spiriva, Boehringer Ingelheim), a long-acting inhaled anticholinergic bronchodilator, improves lung function, quality of life, and exercise endurance and reduces exacerbations in patients with chronic obstructive pulmonary disease (COPD).1?4 Tiotropium is approved and marketed as a dry-powder formulation delivered by means of the HandiHaler inhalation device (at a dose of 18 ?g)5 and as an aqueous solution delivered by means of the Respimat inhaler (at a dose of 5 ?g) in many countries.6 Crossover trials of tiotropium Respimat at a dose of 5 ?g and HandiHaler at a dose of 18 ?g for up to 4 weeks have shown . . .
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