Current position of new fixed-dose combination of tiotropium and olodaterol – its role in the treatment of chronic obstructive pulmonary disease in the Czech Republic

Authors: Vladimír Koblížek 1;  Michal Svoboda 2,3
Authors‘ workplace: Plicní klinika LF UK a FN Hradec Králové 1;  Institut biostatistiky a analýz LF a PřF MU, Brno 2;  Ústav zdravotnických informací a statistiky, Praha 3
Published in: Vnitř Lék 2016; 62(12): 1011-1020
Category: Reviews


COPD is a serious pulmonary disease with rising global socioeconomic impact. From the perspective of the Czech Republic COPD was responsible for 21 000 acute hospitalizations and 3 500 deaths, mortality reaches 33/100 000 in 2015. Early stages of disease may be associated with a significant reduction of exercise capacity and the reduction of activities of daily living. Moreover early stages of bronchial obstruction are associated with the fastest lung function decline. Finally, early elimination of the risk of inhalation exposure is able to influence the course of the disease and to reduce its mortality. Most current treatment strategies and national recommendations attributed central role to bronchodilator drugs. Long-acting bronchodilators (LAMA and LABA) creates an essential component of the treatment of symptomatic individuals in the Czech COPD guidelines as well. Actual version of this document constitutes as standard therapy: long-lasting inhaled bronchodilators, targeted efforts to eliminate inhalation risk, vaccination, regular exercise, repeated inhalation technique training, identification, and treatment of relevant comorbidities. All other drugs (inhaled-corticosteroids, mucoactive medication, roflumilast, antibiotics), and non-pharmacological (lung volume reductions, nutrition support, long-term oxygen, home non-invasive ventilation, lung transplantation, palliative care) procedures are intended for a specific subgroups of patients only. The newest type of bronchodilator therapy is represented by a fixed dual bronchodilation. Currently we can use four original drug combinations: titropium + olodaterol, glycopyrronium + indacaterol, umeklidinium + vilanterol and aclidinium + formoterol in the Czech Republic. This area is an enterprising research. For example comprehensive scientific program covering eight studies on 15 000 COPD patients (TOviTO) assess the therapeutic benefits of tiotropium + olodaterolu in terms of lung function, quality of life, exercise tolerance, daily physical activity and the incidence of acute exacerbations. Meanwhile the published results of analyzed studies TONADO, OTEMTO, VIVACITO, and the first results of the study DYNAGITO have showed that fixed dual bronchodilation should be a mandatory treatment to all the symptomatic COPD patients. Unfortunately “face to face” comparison of different drug combinations is still missing. However, the treatment with tiotropium + olodaterol combination has been demonstrated to significantly (35 %) reduce the occurrence of clinically significant deterioration, which may lead to the stabilization of this multicomponent disease.

Key words:
COPD – hospitalizations – inhaled bronchodilators – mortality – treatment


1. [Global Initiative for Chronic Obstructive Lung Disease]. Global strategy for the diagnosis, managment and prevention of COPD. GOLD Report (Updated 2016). [19.2.2016]. Dostupné z WWW: <>.

2. Lamprecht B, McBurnie MA, Vollmer WM et al. COPD in never smokers. Results from the population-based burden of obstructive lung disease study. Chest 2011; 139(4): 752–763. Dostupné z DOI: <–1253>.

3. European COPD Coalition. Prevalence in EU (Updated 2015). Dostupné z WWW: <>. [19.2.2016]

4. López-Campos JL, Ruiz-Ramos M, Soriano JB. Mortality trends in chronic obstructive pulmonary disease in Europe, 1994–2010: a joinpoint regression analysis. Lancet Respir Med 2014; 2(1): 54–62. Dostupné z DOI: <–2600(13)70232–7>.

5. Pike D, Kirby M, Eddy RL et al. Regional Heterogeneity of Chronic Obstructive Pulmonary Disease Phenotypes: Pulmonary (3)He Magnetic Resonance Imaging and Computed Tomography. COPD 2016; 13(5): 601–609. Dostupné z DOI: <>.

6. Russell DW, Wells JM, Blalock JE. Disease phenotyping in chronic obstructive pulmonary disease: the neutrophilic endotype. Curr Opin Pulm Med 2016; 22(2): 91–99. Dostupné z DOI: <>.

7. Ofir D, Laveneziana P, Webb KA et al. Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008; 177(6): 622–629.

8. Waschki B, Kirsten AM, Holz O et al. Disease Progression and Changes in Physical Activity in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2015; 192(3): 295–306. Dostupné z DOI: <–0081OC>.

9. Watz H, Waschki B, Meyer T et al. Physical activity in patients with COPD. Eur Respir J 2009; 33(2): 262–272. Dostupné z DOI: <>.

10. Tantucci C, Modina D. Lung function decline in COPD. Int J Chron Obstruct Pulmon Dis 2012; 7: 95–99. Dostupné z DOI: <>.

11. Coultas DB, Mapel D, Gagnon R et al. The health impact of undiagnosed airflow obstruction in a national sample of United States adults. Am J Respir Crit Care Med 2001; 164(3): 372–377.

12. Kim J, Yoon HI, Oh YM et al. Lung function decline rates according to GOLD group in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10: 1819–1827. Dostupné z DOI: <>.

13. Davis KJ, Landis SH, Oh YM et al. Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries. Int J Chron Obstruct Pulmon Dis 2014; 10: 39–55. Dostupné z DOI: <>.

14. Miravitlles M, Vogelmeier C, Roche N et al. A review of national guidelines for management of COPD in Europe. Eur Respir J 2016; 47(2): 625–637. Dostupné z DOI:–2015>.

15. Hizawa N. LAMA/LABA vs ICS/LABA in the treatment of COPD in Japan based on the disease phenotypes. Int J Chron Obstruct Pulmon Dis 2015; 10: 1093–1102. Dostupné z DOI: <>.

16. Ferguson GT, Fležar M, Korn S et al. Efficacy of Tiotropium + Olodaterol in Patients with Chronic Obstructive Pulmonary Disease by Initial Disease Severity and Treatment Intensity: A Post Hoc Analysis. Adv Ther 2015; 32(6): 523–536. Dostupné z DOI: <–015–0218–0>.

17. Dellacà RL, Pompilio PP, Walker PP et al. Effect of bronchodilation on expiratory flow limitation and resting lung mechanics in COPD. Eur Respir J 2009; 33(6): 1329–1337. Dostupné z DOI: <>.

18. Buhl R et al. American Thoracic Society Conference, May 13-May 18, 2016, San Francisco, California, USA. Abstract 6916.

19. Koblížek V, Chlumský J, Zindr V et al. Chronic obstructive pulmonary disease in the light of new guidelines – brief summary of phenotypically oriented guidelines for nonpulmonary physicians. Vnitr Lek 2013; 59(6): 505–514.

20. Laube BL, Janssens HM, de Jongh FHC et al. What the pulmonary specialists should know about the new inhalation therapies. ERS/ISAM Task force report. Eur Respir J 2011; 37(6): 1308–1331. Dostupné z DOI: <>.

21. Dhillon S. Tiotropium/Olodaterol: A Review in COPD. Drugs 2016; 76(1): 135–146. Dostupné z DOI: <–015–0527–2>.

22. De Soyza A, Calverley PM. Large trials, new knowledge: the changing face of COPD management. Eur Respir J 2015; 45(6): 1692–1703. Dostupné z DOI: <>.

23. Niederseer D, Richter SA, Neunhäuserer D et al. Symptomatic chronic obstructive pulmonary disease in clinical trials and in a population-based study. Sleep Breath 2015; 19(3): 801–808. Dostupné z DOI: <–014–1087–5>.

24. Worth H, Buhl R, Criée CP et al.The ‘real-life’ COPD patient in Germany: The DACCORD study. Respir Med 2016; 111: 64–71. Dostupné z DOI: <>.

25. Campbell S. For COPD a combination of ipratropium bromide and albuterol sulfate is more effective than albuterol base. Arch Intern Med 1999; 159(2): 156–60.

26. Tashkin DP, Li N, Kleerup EC et al. Acute bronchodilator responses decline progressively over 4 years in patients with moderate to very severe COPD. Respir Res 2014; 15: 102. Dostupné z DOI: <–014–0102–5>.

27. Tashkin DP, Leimer I, Metzdorf N et al. Cardiac safety of tiotropium in patients with cardiac events: a retrospective analysis of the UPLIFT® trial. Respir Res 2015; 16: 65. Dostupné z DOI: <–015–0216–4>.

28. Matera MG, Ora J, Cazzola M. Differential pharmacology and clinical utility of long-acting bronchodilators in COPD – focus on olodaterol. Ther Clin Risk Manag 2015; 11: 1805–1811. Dostupné z DOI: <>.

29. Tamura T, Kagohashi K, Satoh H. Clinical improvement by tiotropium plus olodaterol. Respir Med 2016. pii: S0954–6111(16)30040–3. Dostupné z DOI: <>.

30. Buhl R, Maltais F, Abrahams R, Bjermer L, et al. Tiotropium and olodaterol fixed-dose combination versus mono-components in COPD (GOLD 2–4). Eur Respir J 2015; 45(4): 969–979. Dostupné z DOI: <>.

31. Singh D, Ferguson GT, Bolitschek J et al. Tiotropium + olodaterol shows clinically meaningful improvements in quality of life. Respir Med 2015; 109(10): 1312–1319. Dostupné z DOI: <>.

32. Beeh KM, Westerman J, Kirsten AM et al. The 24-h lung function profile of onec-daily tiotropium and olodaterol fixed-dose combination in chronic obstructive pulmonary disease. Pulm Pharm Therap 2015; 32: 53–59. Dostupné z DOI: <>.

33. Beeh KM, Derom E, Echave-Sustaeta J et al. The lung function profile of once-daily tiotropium and olodaterol via Respimat® is superior to that of twice-daily salmeterol and fluticasone propionate via Accuhaler® (ENERGITO® study). Int J Chron Obstruct Pulmon Dis 2016; 11: 193–205. Dostupné z DOI: <>.

Diabetology Endocrinology Internal medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account