Chronic obstructive pulmonary disease (COPD) is a lung disease which includes the conditions chronic bronchitis and/or emphysema. COPD is characterised by blockage or narrowing of the airways. The symptoms include breathlessness and chronic cough. COPD is an irreversible disease that is usually brought on by airway irritants, such as smoking or inhaled dust.
Inhalers with bronchodilators and/or anti-inflammatory agents are commonly used to ease symptoms and minimise the long-term decline in health caused by COPD. Examples of these treatments are tiotropium which is a bronchodilator and combination inhalers which contain another type of bronchodilator (long-acting beta-agonists) together with anti-inflammatory agents (steroids). These treatments work in different ways and therefore might be more beneficial if used together.
This review found three studies, involving 1021 patients, comparing the long-term efficacy and side effects of combining tiotropium with combination inhalers for treating COPD. In these studies there were not enough patients and the studies were too different from each other for us to be able to draw any firm conclusions as to whether combining tiotropium with combination inhalers is better or worse than using either drug alone for mortality, hospitalisation and pneumonia. The addition of combination inhalers to tiotropium did show small benefits in quality of life and lung function tests.
In order to better understand the effect of treatment with tiotropium and combination inhaler more long-term studies need to be done.