New improved inhaler on the horizon

September 2014:


'. . . Once-daily tiotropium + olodaterol FDC [Fixed Dose Combination] is an investigational combination that includes the long-acting muscarinic antagonist (LAMA) tiotropium with olodaterol, a long-acting beta agonist (LABA), delivered via the propellant-free Respimat® inhaler, which generates a slow-moving mist.

The pivotal 52-week TONADO™ 1&2 studies included more than 5,500 patients with COPD. Results showed that lung function, as measured by trough forced expiratory volume in one second (FEV1), improved in patients receiving tiotropium + olodaterol FDC delivered via the Respimat® inhaler, and that St. George’s Respiratory Questionnaire (SGRQ) total score was affected favorably compared to those receiving olodaterol or tiotropium alone. . . .'

Trough FEV1responses at 24 weeks:

Olodaterol 5 μg 55 ml

Tiotropium 5 μg 80 ml

T+O 5/5 μg 140 ml

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45 Replies

  • Hi stilltrukin hope your keeping well. That all sounds great I wonder when it will be out here for us to use? I use the respimat and find it far better inhaling a mist rather than the powder,that's me though. I continued to read down the page after that article and I see they are questioning inhaled steroids now which to me I find very interesting as I stopped using them over 15years ago due to severe thrush regardless of the rinsing of my mouth and have sometimes worried that I havnt helped myself? The same with the taking of prednisolone ,I try not to take and if I really need to only for a short period of 2-3 days. Touch wood I have been lucky and don't seem to suffer to badly with infections at all. My doc has also now said that the thinking on steroids has changed some and has told me to try not to take steroids as they themselves make us more prone to infection etc. it's all very interesting for sure. Do hope that the new respimat will be available soon.

    Blessings to you. :) Jane xx

  • I'm doing ok. Recently had a spirometry test at the docs which gave the same result as two years ago, which can't be bad.

    I use Seretide 250, but have never needed oral steroids as yet. I hear they give you quite a buzz . . .

  • Thats great news stilltruckin you must be made up with that result.Again interesting you havnt taken steroids as yet and your health is good,is that a concious decision on your part ,not feeling the need for them or your infections havnt warranted their use?Youstay clear of them if possible.They are a brilliant drug when really needed but I do believe our docs have handed them out to readily sometimes.As for their buzz well I do find I need more sweet things as my tongue gets very sore and my appetite generally increases like getting the munchies from cannabis.My father used to get very enthusiastic and busy on them he had to take alot for long periods.I guess we are all so very different in the way we react to all these drugs.At the moment Im umming and arring as to wether to take vitamin A to increase more eggs is a negative as they are so high in colesterol .Im not normally one to take suplements have enough trouble swallowing the necessary ones we have to take.What are your thoughts on these?

    Blessings to you :) Janexx

  • Yes, that result pleased me. Shows I could be on the right track with at least some of the many supplements I take - plus my exercise regimen of course.

    The last time I had the flu was 7 or 8 years ago, before my COPD had become severe enough to affect me much. I was still smoking 20 a day and not using any meds, not even Ventolin. Didn't see a doctor, just went to bed for a week or so.

    Since then I haven't used steroids, or antibiotics for that matter, because I've never needed them. I have good days and not-so-good days as measured by how breathless exercise makes me, but no serious infections or exacerbations - so far.

    I take 10 500 IU/day of vitamin A, amongst other things (8000 IU capsule + 2500 IU in my multivit). The vitamin A capsules I take are tiny. They'd give you no problem. Otherwise buy a bottle of pure cod liver oil and take 2 or 3 teaspoonfuls a day.

  • Hi stilltrucking wowsa you have done well how brilliant is that you definitely are doing something right.The medics should be looking at you and seeing what could be learned?

    Thank-you for your info on vitA will give them ago I fancy. Blessings Janexx

  • Hi Jane - thought you might be interested in this link which talks about the benefits of eggs. Seems the old thoughts on cholesterol are out of date (many more sites on this online).

    Ive increased mine to one a day from about 3-4 a week, have it for breakfast and feel massively better, more energetic etc.

    I know theories come and go, but I've seen this re eggs for quite a long time now. My improvement may be consistent with the Vitamin A (retinoid acid) debate on another thread, since eggs contain a lot of it, but who knows? You often can't really tell what has caused an improvement - Im just grateful anyway.

    All best to you :)

  • " Hey and Hello 02trees. i love eggs.. and like you I take vitamins D.. i have with my eggs lots little soldiers.... all cut up into nice thin portions. and spread with home made cannabutter. then dipped into my egg and i find the vitamins in the egg are amazing ...and the pain relief from my home made cannabutter is long last i am now starting to feel a hundred percent better than i have felt in thats what i call improvement....have a lovely weekend, keep well wrapped up, as its still so betterly cold....Megan."

  • What is cannabutter Megan? And you make it yourself? love to know more :)

  • "Awe 02Trees...Nanny49...stilltruckin beat me to it and as sent you a link telling you what cannabutter is. it really works for me.i have only been trying it these past 2 weeks.... I was struggling so bad with such severe pains as i have.. systemic arthritis ....rheumatoid arthritis.... osteoarthritis ....and..osteoporosis along side my COPD Stage 4...i read the said article that stilltruckin sent you and went about trying to make it..i did with success tastes awful but i only use it as a pain killer....I thinly spread it on some dry bread. as if it was butter..... kinda scrap it on...scrap it off....then spread raspberry jam onto it..and with a nice cuppa tea... i for the first time in a long time feel totally pain i said in my post.i love it also with my two hard boiled eggs that i have with solders for my breakfast... yummy yums...Megan..

  • Of course, silly me. Im incredibly fortunate not to have much pain at this point, but i'll remember this for the future.

    Does the cannabis have to be in butter?

    Couldn't you make chocolate brownies Megan?

    Much tastier :)

  • Hi Megan - would love to know what cannabutter is and how you make it.

  • Cannabis-infused butter:

  • Hi O2Trees thank-you for the link Iam definitely behind the times re eggs and very pleased that they can be back on the menu without the guilt.Iam very partial to my eggs so am a happy bunny.

    Yes it was because of that thread that I was contemplating it even though its the retinoic acid from the egg .It would be fantastic if they can tweak the formula for a more positive result in regeneration of our holey lungs.Think I will get some and give it ago,it would be good to have a picture of lungs before and another aftera year and see if there are any changes afoot.Its all very interesting stuff,plus the news on the new Spiriva combo being trialled ,shall look forward to that being available in the future hopefully.

    Im really glad that youhave had such an improvment that is always good news and more so if its got any relation to the extra eggs your now enjoying. :) Blessings Janexx

  • It would be interesting to know how these results compare to Spiriva and Symbicort or Seretide.

    What does "trough" mean in this context?

  • Maybe trough means the FEV1 before taking ventolin for reversibility. Or maybe the worst of the three they always do, but I'm totally guessing, no idea really so as interested as you to hear what it means.

    And I'm interested in your first question too :)

  • Trough FEV1 is the measurement taken in the morning before the days first dose of bronchodilator.

    Spiriva is tiotropium. The bronchodilator component of Symbicort is formoterol, and that of Seretide is salmeterol.

    Salmeterol, formoterol and olodaterol are beta2- agonists. Salmeterol and formoterol work for 12 hours, olodaterol works for 24 hours. Tiotropium is an antimuscarinic that works for 24 hours.

    In terms of FEV1 improvement salmeterol, formoterol and olodaterol all have a similar efficacy, and tiotropium is better:


    'On isolated human bronchi, olodaterol dose-dependently reversed the constriction induced by different stimuli, such as histamine, ACh, and EFS with an efficacy not statistically different from formoterol under all conditions.'


    '. . . These findings demonstrate that formoterol 12 μg b.i.d.[twice a day] and salmeterol 50 μg b.i.d., both formulated as dry powders, have similar long-term efficacy and safety profiles in patients with reversible obstructive airways disease.'


    'After 169 days of treatment, the mean improvement above placebo in trough FEV1 was 110 mL for tiotropium and 80 mL for salmeterol.'

  • Thanks ST, I thought you would have the answers.

  • Were any of the subjects taking inhaled steroids e.g. symbicort, Stilltruckin?

    Very interesting research.

  • hiya o2 troughs mention in this link ,your right it is connected to fev1 .

  • Yes, found it, thanks itsBAme.

    "Trough FEV1 is the measure taken in the morning prior to first dosing of inhaled medications."

  • ,, found this on it o2.

  • ,,if im right on this link o2 its been on goin from 2012.,,

  • I'm sure it would have been mentioned if the subjects were using inhaled steroids.

  • Now that I've finally learned how to use it, I find the current Spiriva Respimat excellent. The new combination sounds very promising.

  • Thanks stilltrucking. I found the article really interesting. Sounds very favourable for us. Hopefully it will be approved for sale soon. I'm willing to try almost anything!

    Hope you are keeping well.


  • This seems to be the most recent report (Jan 2015):


    ' Boehringer Ingelheim today announced that the first patient has been enrolled into its large-scale DYNAGITO® study.1 It will assess the potential benefit of tiotropium + olodaterol Respimat® FDC† compared to Spiriva® (tiotropium) Respimat®‡ on reducing the risk of sudden worsening of symptoms (exacerbations) and improving survival in patients with COPD. The 52-week study aims to involve 7,800 patients in 59 countries. Results are expected in 2017.'

  • My recent experience of inhalers is trying out 'Onbrez' (indacterol) and Seebri (Tiotropium) I tried the Seebri first and felt ill all week. Once I used the Onbrez I did not look back! I had to get used to them being in powder form, but I am used to it now. One puff of Onbrez once a day, and I feel great. I have oral steroids daily. My steroids were given to me by my oncologist, not my pnemonologist. I am seeing my GP today to discuss all my meds....if he can dig himself out of his village. It has been snowing here big time! (South west France!)

  • Seebri is glycopyrronium not tiotropium, although they're both muscarinic antagonists while indacterol is a b2 agonist like salmeterol and formoterol, but lasts 24 hours instead of 12.

  • My doctor just gave me Seebri and Onbrez and said to take the Seebri first followed immediatly by the Onbrez. Are you taking both or just the Onbrez and have you gotten to the Seebri if you are still using both?


  • Hi Stilltrucking, thank you for great post, some times I forget how science is striving to find better results! I thought I'd experiment on myself and stopped taking the Spiriva and Seretide 500 for a couple of days and see what I was like without them....I found I could barely walk downstairs never mind up! No harm done, I just needed to know :D Have a great weekend! huff xxx

  • Same with supplements. When you start taking them you can begin to feel the difference after a while, particularly if you've got a full-blown deficiency, but a year on you'll just feel 'normal'. Stop them and a few months later you'll remember why you started . . .

  • so basically its the same as my fostiar and spiriva,but in a mist,is this correct ?

  • Great post Stilltruckin. I wonder if this new drug will help those with Bronchiectasis?

    I take Symbicort daily and occasionally Ventolin inhaler. I used to take Ventolin via nebuliser, but found it made my heart go haywire. However, this is the first Winter I have spent at home in twenty years and feel that I have detériorated due to the cold and damp weather. A new drug would certainly be helpful to me and I am sure everyone on this site.

    Great news that you are doing so well,


  • I've just been moved from Spiriva to SeeBri .... (suspect a cost thing!). No comment yet concerning effectiveness, although first reactions is that SeeBri is far easier than Spiriva to take.

    I'll give it a week .... 'watch this space' is all I can say at the moment.

    Does anyone have thoughts or experience of QVA149 .... apparently some form of dual inhaled med that I remember reading about a while back.

  • I would like to keep a clone of 'stilltrukin' in my meds cupboard ..... you knows your stuff.

  • Hi Stilltruckin a interesting post I'm on a PR course at the moment and a lady on the course has been feeling really unwell for a long time her GP put her on Symbicort and she feels fantastic now.

    What exercise do you do you have done really well not having the flu for all those years, I thought I had done really well when I was first diagnosed I stayed the same for 3 years then I got the flu.

  • I clock up a total of 1600 metres a day, every day, on a cross-trainer in stages of 120-150 metres at a time. This leaves me moderately breathless, which is the point to aim for.

    When I first started this regimen, about 15 months ago, I could only manage about 300 metres a day in stages of 50 metres at a time. But I soon began feeling the benefit and added an extra 100 metres to my daily total at weekly intervals.

    At one point I got up to 2400 m/day, but found that too time consuming for the long term.

    Also go up and down the stairs about a dozen times a day (weak bladder) . . .

  • Wow well done as you know I go swimming but I would like to use a cross trainer I know some members on hear have treadmills. I'm doing a exercise plan with my PR course and if anything has come out of that is exercise is very important to us all so I will be looking for a cross trainer that folds flat

  • Hi everyone I wish I could exercise more ,I have Emphysema as you know stilltruckin.

    I also have Fibromyalgia, plus Osteoarthritis in my feet/toes hands and other joints.

    I'm on Spiriva plus Salbutamol Easi Breath.

    Plus 5mg morphine for the Fibro pain,and Paracetamol.

    I can't walk far so do not go out much at all except for doctors/hospital/ dentist appointments.

    So I do my exercises more sitting down,ie arms and leg stretches...that's about all I can manage physically plus walking with stick to and fro to kitchen/bathroom etc.

    Ooops sorry gone off topic,but It's great to be able to interact with you all though.

    Thank you.:)

  • Whatever exercise you do, do it until you're moderately breathless. This will condition your body to use oxygen more efficiently.

  • I'm fortunate I am not yet on oxygen,I dread the thought of that.

    I actually get breathless and in pain just bending over/down or even drawing the curtains even standing too long I'm in dreadful pain right through my chest to my back between shoulder blades.

    Silly things that one takes as normal.

    Good job I have my husband as my carer.

    When / if I go to the town husband puts the wheelchair in back of car in case I need it,I use a walking stick,don't want to give in to the wheelchair,but I usually end up in it.

    Husband will sit me on a seat,and go back to car and get wheelchair.

    Sorry to waffle on,but it's good to offload sometimes,thank you.

    Hope the Oxygen will be a long way off anyway.

  • I trust you realise that when in my last post I refer to using oxygen more efficiently I mean atmospheric oxygen (although it would equally apply to oxygen from a tank, of course).

    And to be clear, only when breathlessness is caused by the muscles using oxygen faster than the lungs can replace it is there any benefit. Breathlessness from bending over or otherwise inhibiting breathing does you no good.

    It may seem obvious, but I know things are only obvious when you've forgotten learning them . . .

  • Hi Stilltrucking.

    Thanks for this post very intresting but always like to read your posts and veiws and comments about copd.

    Lucky you dont live in our road has would be forever chatting and asking you questions on what you think about things LOL.

    Thanks for info

    Beat wishes


  • Hi Ginger,

    Why not look at the wheelchair and the oxygen as prescription drugs to be used as you need them? At times you need them to give quality of life. They are tools to be used when you need them. I dreaded being on oxygen, but I have found its use to be so helpful, and, once I got used to people giving me 'funny' looks, I just get on with it. I am just about to ask for the use of a wheelchair, as we are going to the UK for a holiday in April, so for shopping I will need one.

  • stilltruckin :)

    Yes,I did misunderstand about the oxygen silly me.

    I have only been at our new home (bungalow) for three months,and as yet other than an OT lady assess me for things I need here like hand rails inside and out/perching stool,and a radiator put in by the housing association.

    I contacted the new doctor here yesterday,as I am due a Spirometry test, she/he has booked me in for one the week after next,and from there I will be referred to the hospital again in the nearest town,hopefully,to see a new Consultant.

    Lolly2 :)

    Thank you for your advice on using my wheelchair etc,it is a godsend when shopping/browsing the shops only actually,as hubby does all food shopping.

    Hope you have a lovely holiday when the time comes.:)

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