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N Engl J Med. 2017 Sep 7;377(10):923-935. doi: 10.1056/NEJMoa1700228.

Tiotropium in Early-Stage Chronic Obstructive Pulmonary Disease.

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From the National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital (Y.Z., N.Z., Xiaochen Li, S.C., J. Zheng, D.Z., W.G., P.R.), the Third Affiliated Hospital (L.W., G.H.), and Liwan Hospital (F.L., Y.C.), Guangzhou Medical University, Guangzhou Panyu Center Hospital (R.Z., Yinhuan Li), the First Affiliated Hospital, Sun Yat-sen University (C.X.), and the First Affiliated Hospital of Jinan University (S.L.), Guangzhou, Chenzhou No. 1 People's Hospital, Chenzhou (B. He, H.T.), Guizhou Provincial People's Hospital, Guizhou (X. Zhang, X.Y.), Wengyuan County People's Hospital (C. Yang, Lizhen Zeng, C. Ye) and Shaoguan Iron and Steel Group Company Limited Hospital (T.C.), Shaoguan, Henan Provincial People's Hospital, Zhengzhou (Ying Li, X.M.), the Affiliated Hospital of GuiYang Medical College, GuiYang (J.D., X.H.), the Second People's Hospital of Hunan Province, Changsha (J.G., J.T.), Huizhou First Hospital, Huizhou (B. Hu, Z.S.), Affiliated Zhongshan Hospital of Fudan University (C.B., X. Zhu) and Shanghai Xuhui Central Hospital (R.Y.), Shanghai, Shenzhen Sixth People's Hospital, Shenzhen (P.H., X.D.), the First People's Hospital of Foshan, Foshan (G.C., M.L.), Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan (Y.X., J. Zhao), Xinqiao Hospital, Chongqing (C.W., Q.M.), the Affiliated Hospital, Guangdong Medical University (W. Yao, B.L.), and the Second People's Hospital of Zhanjiang (Xiongbin Li), Zhanjiang, Beijing Chao-Yang Hospital, Beijing (Y. Lin), and Lianping County People's Hospital, Heyuan (W. Ye, X. Luo, Lingshan Zeng, S.Y.) - all in China.



Patients with mild or moderate chronic obstructive pulmonary disease (COPD) rarely receive medications, because they have few symptoms. We hypothesized that long-term use of tiotropium would improve lung function and ameliorate the decline in lung function in patients with mild or moderate COPD.


In a multicenter, randomized, double-blind, placebo-controlled trial that was conducted in China, we randomly assigned 841 patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 (mild) or 2 (moderate) severity to receive a once-daily inhaled dose (18 μg) of tiotropium (419 patients) or matching placebo (422) for 2 years. The primary end point was the between-group difference in the change from baseline to 24 months in the forced expiratory volume in 1 second (FEV1) before bronchodilator use. Secondary end points included the between-group difference in the change from baseline to 24 months in the FEV1 after bronchodilator use and the between-group difference in the annual decline in the FEV1 before and after bronchodilator use from day 30 to month 24.


Of 841 patients who underwent randomization, 388 patients in the tiotropium group and 383 in the placebo group were included in the full analysis set. The FEV1 in patients who received tiotropium was higher than in those who received placebo throughout the trial (ranges of mean differences, 127 to 169 ml before bronchodilator use and 71 to 133 ml after bronchodilator use; P<0.001 for all comparisons). There was no significant amelioration of the mean (±SE) annual decline in the FEV1 before bronchodilator use: the decline was 38±6 ml per year in the tiotropium group and 53±6 ml per year in the placebo group (difference, 15 ml per year; 95% confidence interval [CI], -1 to 31; P=0.06). In contrast, the annual decline in the FEV1 after bronchodilator use was significantly less in the tiotropium group than in the placebo group (29±5 ml per year vs. 51±6 ml per year; difference, 22 ml per year [95% CI, 6 to 37]; P=0.006). The incidence of adverse events was generally similar in the two groups.


Tiotropium resulted in a higher FEV1 than placebo at 24 months and ameliorated the annual decline in the FEV1 after bronchodilator use in patients with COPD of GOLD stage 1 or 2. (Funded by Boehringer Ingelheim and others; Tie-COPD number, NCT01455129 .).

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