Long-acting bronchodilators are the cornerstone of pharmacologic treatment of chronic obstructive pulmonary disease (COPD). Spiolto (R) or Stiolto (R) is a fixed-dose combination (FDC) containing two long-acting bronchodilators, the long-acting muscarinic receptor antagonist tiotropium (TIO) and the long-acting beta 2-adrenoceptor agonist olodaterol (OLO), formulated in the Respimat (R) Soft Mist (TM) 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 mu g FDC significantly increases pulmonary function compared with placebo and its respective constituent mono-components TIO 5 mu g and OLO 5 mu g. TIO/OLO 5/5 mu g 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 mu g to TIO 5 mu g reduces the rate of moderate-to-severe exacerbations by approximately 10%. Compared with placebo and TIO 5 mu g, TIO/OLO 5/5 mu g 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 mu g 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 mu g in the management of patients with symptomatic COPD
