12 Week Efficacy of Tiotropium Versus Placebo in Patients With Mild COPD According to Swedish Guidelines (SPIRIMILD)
12 Week Efficacy of Tiotropium Versus Placebo in Patients With Mild COPD According to Swedish Guidelines (SPIRIMILD)
To show that treatment with tiotropium inhalation capsules (18 μg q.d.) via HandiHaler®
 improves lung function in patients with mild COPD according to Swedish guidelines.
Following an initial screening at the screening visit(Visit 1), patients enter a 2 week
 run-in period. Patients are allowed to take salbutamol (Ventoline, Diskus, 0.2 mg) prn as
 rescue medication and have to record their daily use of it on the Patient's Diary. Patients
 who meet all inclusion and none of the exclusion criteria at the check at Visit 2 will be
 randomised thereafter into the randomised treatment period of the study during which they
 will receive either tiotropium(Spiriva) or placebo in blinded fashion.

 On Day 0 (Visit 2), the first administration of blinded study medication (tiotropium(Spiriva)
 or matching placebo) will be performed at the study site, after a pre-dose pulmonary function
 test (PFT) has been carried out. First administration of blinded study medication will be
 monitored by the investigator. Post dose PFTs will be performed at 30 min, 1 and 2 hours.

 On Days 1 to 83 except Day 14, the blinded study medication will be self-administered by the
 patients at home. The patients will inhale one capsule (tiotropium)(Spiriva) or matching
 placebo) using the HandiHaler device once daily in the morning. The morning dose of the
 blinded study medication should be taken at approximately the same time each morning between
 7:00 a.m. and 10:00 a.m.

 At visit 3 and 4 PFTs will be performed predose and post dose at 30 minutes, 1 and 2 hours

 Study Hypothesis:

 The rationale of the study is to show that treatment with tiotropium (Spiriva) 18 ?g
 inhalation capsule via HandiHaler once daily improves FEV1 when compared with placebo in
 patients with mild COPD according to Swedish guidelines, i.e., a post-bronchodilator FEV1 <
 60% of predicted normal and FEV1 < 70% of FVC.

 Comparison(s):

 One group will be treated with inhalation powder capsules of tiotropium (Spiriva), 18
 micrograms once daily. The other group will be treated with matching placebo. Randomisation
 is 1:1
Inclusion Criteria:

 1. Patients who have signed an written informed consent consistent with ICH GCP
 guidelines and local legislations prior to participation in the trial.

 2. Patients with a diagnosis of COPD. COPD is defined as a disease state characterised by
 the presence of airflow obstruction often due to chronic bronchitis or emphysema; the
 airflow obstruction is generally progressive, may be accompanied by airway
 hyperreactivity, and may be partially reversible.

 3. Patients 40 years of age or older without any restriction to sex.

 4. Patients who currently smoke or who are ex-smokers with a cigarette smoking history of
 >10 pack-years.

 5. Patients who have a relatively stable airway obstruction (at least 4 weeks free of
 COPD exacerbations) with a post bronchodilator FEV1 ? 60% of predicted normal, a post
 bronchodilation FEV1 < 70% of FVC, and a MRC symptom score minimum of 2 at Visit 1

 Exclusion Criteria:

 1. Patients with a history of asthma, allergic rhinitis, atopy, or who have a total
 (absolute) blood eosinophil count ? 600 per mm3 (= 0.6 * 109/L) of the first
 determination at Visit 1

 2. Patients with known moderate or severe renal insufficiency.

 3. Patients with a recent history (i.e., 6 months or less prior to Visit 1) of myocardial
 infarction.

 4. Patients with any unstable or life threatening cardiac arrhythmia, including patients
 with a newly diagnosed, clinically relevant arrhythmia on the electrocardiogram (ECG)
 performed at Visit 1 as well as patients with cardiac arrhythmia requiring an
 intervention (i.e., hospitalisation, cardioversion, pacemaker placement, and automatic
 implantable cardiac defibrillator (AICD) placement) or a change in drug therapy during
 the last year prior to Visit 1.

 5. Patients who regularly use oxygen therapy.

 6. Patients with known active tuberculosis.

 7. Patients with a history of cancer within the last 5 years. Patients with treated basal
 cell carcinoma are allowed.

 8. Patients with a history of life threatening pulmonary obstruction or a history of
 cystic fibrosis or clinically evident bronchiectasis.

 9. Patients who have undergone thoracotomy with pulmonary resection.

 10. Patients who are currently in a pulmonary rehabilitation program or who have completed
 a pulmonary rehabilitation program in the 6 weeks prior to the screening visit (Visit
 1).

 11. Patients with known hypersensitivity to anticholinergic drugs, lactose or any other
 components of the inhalation capsule delivery system.

 12. Patients with known symptomatic hyperplasia or bladder neck obstruction. Patients
 being treated for prostatic hyperplasia and report minimal symptoms may be included
 and should continue their medications.

 13. Patients with known narrow-angle glaucoma.