Alternative mechanisms for tiotropium

Pulm Pharmacol Ther. 2009 Dec;22(6):533-42. doi: 10.1016/j.pupt.2009.06.002. Epub 2009 Jul 25.


Tiotropium is commonly used in the treatment of chronic obstructive pulmonary disease. Although largely considered to be a long-acting bronchodilator, its demonstrated efficacy in reducing the frequency of exacerbations and preliminary evidence from early studies indicating that it might slow the rate of decline in lung function suggested mechanisms of action in addition to simple bronchodilation. This hypothesis was examined in the recently published UPLIFT study and, although spirometric and other clinical benefits of tiotropium treatment extended to four years, the rate of decline in lung function did not appear to be reduced by the addition of tiotropium in this study. This article summarizes data from a variety of investigations that provide insights into possible mechanisms to account for the effects of tiotropium. The report summarizes the discussion on basic and clinical research in this field.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acetylcholine / physiology
  • Animals
  • Bronchodilator Agents / pharmacology*
  • Bronchodilator Agents / therapeutic use
  • Cholinergic Antagonists / pharmacology*
  • Cholinergic Antagonists / therapeutic use
  • Cough / drug therapy
  • Cough / physiopathology
  • Humans
  • Inflammation / pathology
  • Lung / innervation
  • Lung / physiology
  • Mucus / metabolism
  • Parasympathetic Nervous System / drug effects
  • Respiratory System / drug effects
  • Respiratory System / pathology
  • Scopolamine Derivatives / pharmacology*
  • Scopolamine Derivatives / therapeutic use
  • Tiotropium Bromide


  • Bronchodilator Agents
  • Cholinergic Antagonists
  • Scopolamine Derivatives
  • Acetylcholine
  • Tiotropium Bromide