Early COPD can refer to the destruction/loss of the terminal/transitional bronchioles that arises before a deterioration in lung function is demonstrated. It can manifest in the absence of emphysematous destruction, with surviving airways exhibiting narrowed lumens/thickened walls. Defining “early COPD” can be challenging, with the 2023 Global Initiative for Obstructive Lung Disease (GOLD) guidelines preferring a “biologic” to “clinical” definition.

According to the 2023 Global GOLD guidelines, all COPD patients can be started on a long-acting muscarinic antagonist (LAMA), with treatment increases as needed. Treatments should be tailored based on patient needs. Furthermore, the report recommends LAMA plus long-acting beta-agonist (LABA) as initial treatment option in Group B and Group E COPD patients, with single inhalers being a more convenient/effective option than multiple inhalers.

Data suggest that the LAMA, tiotropium bromide, enhances lung function, slows annual declines in FEV, and decreases the need for rescue inhalers. Moreover, findings from short- and long-term randomized, controlled clinical trials involving tiotropium use in COPD patients have suggested that it is safe and improves health-related quality of life and exercise endurance when compared with placebo or active comparators. It also reduces dyspnea and lung hyperinflation.

Tiotropium bromide inhalation spray is the only LAMA that delivers a soft mist designed to be gentler on damaged lungs because use of the soft mist inhaler (SMI) requires minimal inspiratory effort vs. other inhaler types.

What is your protocol for initiating early treatment in COPD patients? What have your experiences been with tiotropium bromide soft mist inhalation spray?