In two RCTs, patients with moderate to severe COPD who were treated with tiotropium experienced larger increases in FEV1 than patients treated with ipratropium after four to twelve weeks of treatment. However, other spirometry measures typically did not differ between treatments over this time period. Further, symptoms of COPD did not differ between tiotropium and ipratropium and other important outcomes such as functional capacity and quality of life were not assessed. Thus, it is unclear whether the larger gain in FEV1 that was experienced by patients treated with tiotropium was clinically important or significant from a patient perspective. As such, other factors such as ease of administration, dosing frequency, and cost may be important points to consider when making policy decisions about coverage for these two agents.