Tiotropium for preventing COPD exacerbations: In patients with moderate-to-severe chronic obstructive pulmonary disease (COPD), a long-acting anticholinergic agent, tiotropium, was more effective than a long-acting ß 2 -agonist, salmeterol, in preventing exacerbations. This is the conclusion of a one-year multicentre trial in 25 countries in which 7376 patients with moderate to severe COPD and a history of at least one exacerbation in the previous year were randomly assigned to treatment with

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... ther tiotropium or salmeterol, in addition to their usual medications for COPD. About half the patients smoked throughout the trial. Compared with salmeterol, tiotropium increased the time to first exacerbation by 42 days (187 v. 145), corresponding to a 17% risk reduction (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.77-0.90, p < 0.001). Over the study year, tiotropium also reduced the risk of moderate exacerbations by 14% (HR 0.86, 95% CI 0.79-0.93, p < 0.001) and severe exacerbations by 28% (HR 0.72, 95% CI 0.61-0.85, p < 0.001). In this industry-sponsored trial, the incidence of serious adverse events was similar in both groups, as was discontinuation of treatment. See N Engl J Med 2011; 364: 1093-103.