A Cochrane review [Abstract] 1 included 2 studies with a total of 1 073 subjects with moderate to severe COPD (average forced expiratory volume in one second (FEV1) was 40% the predicted value). One study used tiotropium via the HandiHaler (18 µg) for 12 months and the other via the Respimat device (5 µg and 10 µg) for 12 weeks.
Trough FEV1 values at 3 months significantly increased with tiotropium compared to ipratropium bromide (MD 109 mL, 95% CI 81 to 137, statistical heterogeneity I2 = 62%; 2 studies, n=1 073). There were fewer COPD exacerbations and hospital admissions with tiotropium compared with ipratropium (table T1). There was no significant difference in mortality between the treatments. One study measured quality of life using the St George's Respiratory Questionnaire (SGRQ); the scale runs from 0 to 100 and lower on the scale indicates a better quality of life. The mean SGRQ score at 52 weeks was lower in the tiotropium group than the ipratropium group (MD -3.30, 95% CI -5.63 to -0.97). There were fewer people experiencing one or more non-fatal serious adverse events on tiotropium compared to ipratropium. There also were significantly fewer withdrawals from the tiotropium group.
| Outcome | Relative effect (95% CI) | Assumed risk - ipratropium(95% CI) | Corresponding risk - tiotropium (95% CI) | Participants (studies) |
|---|---|---|---|---|
| Hospital admissions (all-cause) | OR 0.34 (0.15 to 0.76) | 84 per 1000 | 30 per 1000(14 to 65) | 538(1) |
| Patients with one or more exacerbations | OR 0.71 (0.52 to 0.95) | 297 per 1000 | 231 per 1000(180 to 286) | 1 073(2) |
| Mortality (all-cause) | OR 1.39(0.44 to 4.39) | 11 per 1000 | 15 per 1000(5 to 47) | 1 073(2) |
| All-cause serious adverse events | OR 0.50 (0.34 to 0.73) | 176 per 1000 | 97 per 1000(68 to 135) | 1 073(2) |
| Withdrawals | OR 0.58 (0.41 to 0.83) | 193 per 1000 | 122 per 1000(89 to 166) | 1 073(2) |
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