Tiotropium bromide: Continuing the path of a long-acting bronchodilator in contemporary real-world clinical practice

Inhaled bronchodilator therapy remains an integral part of treatment for patients with COPD and bronchial asthma. This article presents an analytical review of Russian and international literature from the past three years devoted to the first-ever selective, long-acting anticholinergic inhaled bronchodilator, tiotropium bromide (TB). A search of PubMed and eLIBRARY.RU using the keyword “tiotropium bromide” was conducted, and 213 articles were reviewed. Forty articles containing the results of clinical trials of TB – randomized, comparative, and observational – were selected for analysis. A significant number of articles were excluded due to duplicate descriptions of the same studies. This article presents studies that continue to study TB and have demonstrated the reliability of its bronchodilator effect and a high degree of safety. The extrapulmonary effects of TB are described. Particular attention is paid to liquid dosage forms, inhalation technique issues, and treatment adherence. Despite the drug’s use for over 20 years, its properties continue to be studied in Russia and abroad, with combinations being developed and delivery methods being improved. The availability of a reliable, long-acting anticholinergic agent as monotherapy, as well as a dual inhaled bronchodilator component or a second bronchodilator in a triple inhalation formulation, increases the likelihood of achieving obstruction control in both COPD and asthma, allowing for a reduction in steroid use or an early transition to biological therapy. The introduction of a metered-dose aerosol inhaler with TB marks a new step toward its use in Russia. The feasibility of using TB for chronic broncho-obstructive diseases as a new metered-dose aerosol inhaler is driven by issues of treatment adherence, patient preferences in choosing a delivery method, and the ability to use inhalers correctly. The introduction of this new dosage form into clinical practice in Russia was recommended at a meeting of federal pulmonology experts in 2025.

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