Enhanced persistence with tiotropium compared with other respiratory drugs in COPD

Respir Med. 2007 Jul;101(7):1398-405. doi: 10.1016/j.rmed.2007.01.025. Epub 2007 Mar 23.


Background: Tiotropium is a once-daily inhaled anticholinergic maintenance treatment with demonstrated effectiveness in chronic obstructive pulmonary disease (COPD).

Objective: To compare persistence of tiotropium-use with other inhaled respiratory drugs in COPD in current clinical practice.

Methods: The PHARMO database includes, among others, drug-dispensing and hospital discharge records for 2> or = million subjects in the Netherlands. All probable COPD-patients were identified by new respiratory drug use (age >54 years) or COPD-hospitalisations. New users of tiotropium, ipratropium, long-acting beta-agonists (LABAs), or fixed combination of LABA and inhaled corticosteroids (LABA+ICS), in 1998-2003, were included in the study. Persistence was assessed quarterly during the first year of follow-up. Patients with a proportion of days covered (PDC) > or =80% were considered persistent. Persistence was analysed using generalised estimating equations model.

Results: About 37% of new users of tiotropium continued treatment for 1 year, compared with 14% for ipratropium, 13% for LABA, and 17% for LABA+ICS. Multivariate analyses showed that tiotropium-users were 2-3 times more persistent with their therapy than patients using ipratropium (relative risk [RR]: 2.0; 95% confidence interval [CI]: 1.8-2.3), LABA (RR: 2.9; 95% CI: 2.4-3.6), or LABA+ICS (RR: 2.4; 95% CI: 2.1-2.8), respectively. Sub-analyses in patients with a prior hospitalisation for COPD showed that 1-year persistence rates were increased for all treatments (varying from 33% for patients using LABA+ICS to 61% for patients using tiotropium), while persistence with tiotropium was again 2-3 times higher compared with other treatments.

Conclusion: Persistence with tiotropium was higher compared to other inhaled respiratory drugs in COPD in clinical practice.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adrenergic beta-Agonists / administration & dosage
  • Adrenergic beta-Agonists / therapeutic use
  • Adult
  • Aged
  • Bronchodilator Agents / administration & dosage*
  • Bronchodilator Agents / therapeutic use
  • Cohort Studies
  • Databases as Topic
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / therapeutic use
  • Humans
  • Ipratropium / administration & dosage
  • Ipratropium / therapeutic use
  • Male
  • Medical Record Linkage
  • Middle Aged
  • Patient Compliance*
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / psychology
  • Scopolamine Derivatives / administration & dosage*
  • Scopolamine Derivatives / therapeutic use
  • Tiotropium Bromide
  • Treatment Outcome


  • Adrenergic beta-Agonists
  • Bronchodilator Agents
  • Glucocorticoids
  • Scopolamine Derivatives
  • Ipratropium
  • Tiotropium Bromide