Tiotropium Bromide: An Update

Josep Lluis Heredia*
S. Pneumologia, Hospital Mutua de Terrassa, c/ Dr. Robert 5, 08221 Terrassa, Barcelona, Spain

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© Josep Lluis Heredia; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the S. Pneumologia, Hospital Mutua de Terrassa, c/ Dr. Robert 5, 08221 Terrassa, Barcelona, Spain; Tel: 937365050; Fax: 937836631; E-mail:


Tiotropium bromide is a once-daily inhaled anticholinergic bronchodilator. It works by blocking the muscarinic receptors in airway smooth muscle. Tiotropium has a wide therapeutic margin, due to its poor gastrointestinal absorption and its very low systemic bioavailability. The drug is mainly indicated in COPD patients. Clinically relevant outcomes such as significant improvements in spirometry, hyperinflation, dyspnea, heath status, acute exacerbations and mortality have been consistently observed in tiotropium clinical trials, and the drug has been shown to reduce the risk of mortality due to cardiac-vascular disease and respiratory failure. The main side effect reported is dryness of the mouth. Some subgroups of asthmatics also seem to respond to anticholinergic drugs: among them, those with the Arg/Arg genotype for the β2-adrenergic receptor and those with a high percentage of neutrophils in sputum.

Keywords: Tiotropium bromide, COPD, lung function, COPD mortality, COPD exacerbations, quality of life..