The once-daily fixed-dose combination of olodaterol and tiotropium in the management of COPD: current evidence and future prospects

Long-acting bronchodilators are the cornerstone of pharmacologic treatment of chronic obstructive pulmonary disease (COPD). Spiolto？ or Stiolto？ is a fixed-dose combination (FDC) containing two long-acting bronchodilators, the long-acting muscarinic receptor antagonist tiotropium (TIO) and the long-acting β2-adrenoceptor agonist olodaterol (OLO), formulated in the Respimat？ Soft Mist？ inhaler. A total of 13 large, multicentre studies of up to 52？weeks’ duration have documented its efficacy in more than 15,000 patients with COPD. TIO/OLO 5/5？μg FDC significantly increases pulmonary function compared with placebo and its respective constituent mono-components TIO 5？μg and OLO 5？μg. TIO/OLO 5/5？μg also results in statistically and clinically significant improvements in patient-reported outcomes, such as dyspnoea, use of rescue medication, and health status. Addition of OLO 5？μg to TIO 5？μg reduces the rate of moderate-to-severe exacerbations by approximately 10%. Compared with placebo and TIO 5？μg, TIO/OLO 5/5？μg significantly improves exercise capacity (e.g. endurance time) and physical activity, the latter increase being reached by a unique combination behavioural modification intervention, dual bronchodilatation and exercise training. Overall, the likelihood for patients to experience a clinically significant benefit is higher with TIO/OLO 5/5？μg than with its constituent mono-components, which usually yield smaller improvements which do not always reach statistical significance, compared with baseline or placebo. This supports the early introduction of TIO/OLO 5/5？μg in the management of patients with symptomatic COPD