{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:44:55Z","timestamp":1792043095694,"version":"4.4.0"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82570065"],"award-info":[{"award-number":["82570065"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MedComm"],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Current Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations emphasize symptom\u2010driven management, which may limit the use of maintenance bronchodilator therapy in patients without dyspnea. In this exploratory post hoc analysis of the tiotropium in early\u2010stage chronic obstructive pulmonary disease (Tie\u2010COPD) trial, we assessed tiotropium in 305 patients with mild\u2010to\u2010moderate chronic obstructive pulmonary disease (COPD) and a modified Medical Research Council dyspnea score of 0 (157 tiotropium, 148 placebo). Over 2 years, tiotropium maintained a higher pre\u2010bronchodilator forced expiratory volume in 1\u00a0s (FEV\n 1<\/jats:sub>\n ) than placebo (adjusted between\u2010group differences 143\u2013183\u00a0mL; all\n p<\/jats:italic>\n \u00a0<\u00a00.001). The lung function benefit was similar across subgroups defined by age, body mass index, symptom burden, blood eosinophil count, GOLD stage, and smoking (all\n p<\/jats:italic>\n for interaction >0.05). The annual exacerbation rate was lower with tiotropium (adjusted incidence rate ratio 0.51, 95% confidence interval [CI] 0.32, 0.82;\n p<\/jats:italic>\n \u00a0=\u00a00.005), as was the risk of a first clinically important deterioration (\n adjusted<\/jats:styled-content>\n \u00a0hazard ratio 0.55, 95% CI 0.43, 0.70;\n p<\/jats:italic>\n \u00a0<\u00a00.001), whereas COPD assessment test and clinical COPD questionnaire scores did not differ. These hypothesis\u2010generating findings indicate that tiotropium may provide benefits in lung function and exacerbations in COPD without dyspnea, suggesting that a strictly symptom\u2010based treatment criterion warrants prospective reevaluation.\n <\/jats:p>","DOI":"10.1002\/mco2.71001","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:49:33Z","timestamp":1789627773000},"source":"Crossref","is-referenced-by-count":0,"title":["Improvements With Tiotropium Maintenance Therapy in COPD Patients Without Dyspnea"],"prefix":"10.1002","volume":"7","author":[{"given":"Zihui","family":"Wang","sequence":"first","affiliation":[{"name":"State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center For Respiratory Medicine & Guangzhou Institute of Respiratory Health The First Affiliated Hospital of Guangzhou Medical University Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junfeng","family":"Lin","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center For Respiratory Medicine & Guangzhou Institute of Respiratory Health The First Affiliated Hospital of Guangzhou Medical University Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guannan","family":"Cai","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center For Respiratory Medicine & Guangzhou Institute of Respiratory Health The First Affiliated Hospital of Guangzhou Medical University Guangzhou 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Medical University Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9856-6912","authenticated-orcid":false,"given":"Xiaohui","family":"Wu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center For Respiratory Medicine & Guangzhou Institute of Respiratory Health The First Affiliated Hospital of Guangzhou Medical University Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suyin","family":"Huang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center For Respiratory Medicine & Guangzhou Institute of Respiratory Health The First Affiliated Hospital of Guangzhou Medical University Guangzhou China"},{"name":"Guangzhou National Laboratory Guangzhou 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