Background: In many countries worldwide, the long-acting anticholinergic drug tiotropium is available as a dry\npowder formulation delivered by means of the HandiHalerÃ?® inhalation device and as an aqueous solution delivered\nvia the RespimatÃ?® Soft Mistââ??¢ Inhaler. Tiotropium HandiHalerÃ?® is a single-dose, dry powder, breath-actuated inhaler\nthat provides delivered doses and lung deposition of tiotropium that are, over a wide range, not influenced by the\nseverity of chronic obstructive pulmonary disease (COPD). Tiotropium RespimatÃ?® is a propellant-free, multi-dose\ninhaler that delivers a metered dose of medication as a fine, slow-moving, long-lasting soft mist, independently of\npatient inspiratory effort. The high fine-particle fraction of droplets produced by the RespimatÃ?® inhaler optimizes\nthe efficiency of drug delivery to the lungs.\nMethods: To help inform the choice of tiotropium inhaler for prescribers and patients, this systematic review\nsummarizes the available pharmacokinetic, efficacy and safety data from comparative studies of tiotropium\nRespimatÃ?® and tiotropium HandiHalerÃ?® in COPD, focusing on the licensed once-daily doses of 5 and 18 Ã?¼g,\nrespectively. Data sources reviewed include publications and abstracts identified from database searches.\nResults: Published evidence from comparative studies suggests that tiotropium RespimatÃ?® 5 Ã?¼g and tiotropium\nHandiHalerÃ?® 18 Ã?¼g provide similar clinical outcomes in patients with COPD.\nConclusions: The findings indicate that physicians can base their decision about an inhaler for tiotropium on\nfactors other than efficacy or safety. These could be patient preference for a particular inhaler, ease of use and the\nefficiency of drug delivery, with the aim of optimizing adherence and clinical outcomes with long-term tiotropium\nmaintenance therapy.
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