Compared with LABAs (formoterol, salmeterol), tiotropium was associated with greater improvement of lung function, but had comparable effects on COPD exacerbations, hospitalizations, dyspnea improvement, health-related quality of life, and all-cause mortality. There was no difference in exacerbation rate and lung function between tiotropium and LABA plus inhaled glucocorticoids (fluticasone). Combination therapy of tiotropium and LABA further improved lung function. The most common adverse event of tiotropium was dry mouth. One meta-analysis showed that long term treatment of tiotropium (1 to 5 years) was associated with a significantly increased risk of cardiovascular death, MI, or stroke. Based on the economic studies identified, tiotropium treatment appears to be cost-effective alternative compared with salmeterol. A cost-effectiveness study should be conducted using clinical outcome measures obtained from recent systematic reviews and meta-analyses, or it should be conducted side by side with a long-term trial that is independent of the support of pharmaceutical companies.