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General medicine
Tiotropium could provide benefits in the early stage of COPD, but further studies are needed
  1. Mario Cazzola,
  2. Paola Rogliani
  1. Department of Experimental Medicine and Surgery, Universita degli Studi di Roma Tor Vergata, Rome, Italy
  1. Correspondence to Professor Mario Cazzola, Experimental Medicine and Surgery, Universita degli Studi di Roma Tor Vergata, Roma 00133, Italy; mario.cazzola{at}

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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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  • Contributors Both MC and PR shared the opinion reported on the commentary.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The authors have been members of Boehringer Ingelheim Speaker Bureau. The Unit of Respiratory Medicine at the Department of Experimental Medicine and Surgery of the University of Rome Tor Vergata, has received funding for research from Boehringer Ingelheim.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.