Tiotropium Monotherapy and Add-On Therapy Indications

For Pulmonary Emphysema (COPD)

The American College of Chest Physicians strongly recommends tiotropium as single-agent maintenance therapy for moderate to severe COPD, including emphysema, with robust evidence supporting its use (Grade 1A recommendation) 1, 2, 3
Long-acting muscarinic antagonists like tiotropium are recommended as monotherapy to prevent moderate to severe acute exacerbations of COPD, improving quality of life, increasing exercise capacity, and reducing exacerbations in COPD patients 1, 2, 3
Tiotropium monotherapy has an acceptable safety profile, with no significant differences in serious adverse events or mortality compared to placebo, and can be used as initial long-acting bronchodilator therapy in symptomatic patients with lung function less than 60% predicted 1, 2, 3, 4

The American Academy of Allergy, Asthma, and Immunology recommends tiotropium Respimat for add-on maintenance treatment in asthma patients aged ≥6 years who are already receiving inhaled corticosteroids, at a dose of 2.5 μg once daily 5
Tiotropium must be added to existing inhaled corticosteroid therapy, not used as a replacement, to improve lung function and extend time to first asthma exacerbation 5