Tiotropium bromide is a once-daily long-acting anticholingeric medication which has been shown to be effective in clinical trials in COPD . Tiotro-pium is probably more effective than short-acting anticholinergic treatment and it has been shown to reduce exacerbations and to improve health-related quality of life . A recent trial has suggested that tiotropium bromide may achieve higher FEVj values than salmeterol for COPD patients . Tiotropium bromide was licensed for clinical use in the UK just prior to publication of this chapter so clinical experience with this medication at the time of publication is confined to clinical trials. See Chapter 11.
New phosphodiesterase inhibitors such as Cilomilast are being developed. Cilomilast has been shown to improve FEVj compared with placebo in a study of 424 patients but there was no difference in quality of life between the groups. Further studies involving newer phosphodiesterase inhibitors are awaited . See Chapter 11.
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