Tiotropium benefits COPD patients and is better than ipratropium

The not-very-easy-to-fool Cochrane Review group has published a meta-analysis of nine RCT's of COPD patients treated with the anticholinergic tiotropium (Cochran Database Syst Rev.2005;(2):CD002876). They concluded that tiotropium reduces exacerbations,reduces hospitalizations, and improves quality of life, a benefit profile shared by the inhaled corticosteroids.That is about as good as a drug seems to get in COPD,at least to date. Mitigating or reversing the long term decline in pulmonary function is still elusive and prolonging survival still is only achieved by long term oxygen administration in those patients with decreased p02s. One of the RCTs involved a head to head comparison with the older ipratropium in which "tio" was the clear winner. It costs more but it seems to be better.I hate to admit it but I can remember a time when anticholinergics were contraindicated in COPD because it would "dry up" secretions and impede expectoration.