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Commentary on: Zhou Y, Zhong NS, Li X, et al. Tiotropium in early-stage chronic obstructive pulmonary disease. N Engl J Med. 2017;377:923–935.
Although bronchodilators are the first-line maintenance treatment for chronic obstructive pulmonary disease (COPD), we still ignore what their real role is in treating obstructed asymptomatic patients.1 For this reason it is still not well established if we must use long-acting bronchodilators in all patients with COPD. This is a critical issue because many patients suffering from COPD do not complain about the classic disturbing symptoms of COPD such as cough, sputum and dyspnoea, despite the present of a mild and even moderate airflow obstruction as measured by spirometry.2 ,3
A multicentre randomised trial4 of over 800 Chinese COPD patients with mild to moderate [Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 or 2] disease, whose majority (about 90%) had a modified Medical Research Council (mMRC) dyspnea scale score <2 and a …
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