[Tiotropium as new quality medication in the COPD management]

Chronic obstructive pulmonary disease (COPD) is heterogenous syndrome characterised by irreversible progressive airflow limitation caused mainly by tobacco smoking. In the continous bronchomotor tone of normal airways has a cholinergic component mediated via muscarinic cholinergic receptors. Cholinolitic bronchodilators act by blocking muscarinic receptors participate. Tiotropium bromide is an cholinolitic bronchodilatator that antagonises muscarinic receptors and dissociates more slowly from M1 and M3 than from M2 and subsequently has a long duration of action. Tiotropium reduces the number of exacerbations, increases time to first exacerbation and improves lung function significant compared with ipratiopium. Tiotropium produces superior bronchodilation, improvements in dyspnea, health related quality of life compared to ipratropium and salmeterol in patients with COPD. The use of tiotropium is associated with sustained reduction of lung hyperinflation at rest and during exercise. Tiotropium in combination with pulmonary rehabilitation produces clinically improvement in dyspnea, health status endurance of constant work compared to pulmonary rehabilitation alone. Many studies support the use of tiotropium once-daily as first line maintenance treatment in patients with COPD.