Tiotropium (Spiriva): a once-daily inhaled anticholinergic medication for chronic obstructive pulmonary disease.

Tiotropium represents a new generation of inhaled therapy. No other inhaled product has demonstrated effectiveness with once-daily dosing. Treatment has been associated with improved lung function, decrease in the number of exacerbations, increase in the time to first exacerbation, and improved quality of life. Adverse effects appear to be mild in nature, and the only significant adverse effect is dry mouth. Clinical trials show that tiotropium is more effective than placebo. When compared with current treatment for chronic obstructive pulmonary disease, tiotropium is at least as effective as salmeterol and more effective than ipratropium; moreover, the once-a-day dosing increases the likelihood of patient compliance. The guidelines of the Global Initiative for Chronic Obstructive Lung Disease recommend bronchodilator medications as first-line therapy in the symptomatic management of chronic obstructive pulmonary disease. Tiotropium, an anticholinergic bronchodilator, should be considered a first-line agent for patients with chronic obstructive pulmonary disease.