What do systematic reviews say?

Tiotropium vs ipratropium

Tiotropium showed no clear difference in mortality (all‐cause) compared with ipratropium (moderate certainty).

• Tiotropium versus ipratropium bromide for chronic obstructive pulmonary disease 2015 · Cochrane Headline outcomes only
  OR 1.39 [0.44, 4.39]
  2 studies · 1073 participants
  Moderate

Tiotropium vs long‐acting beta‐agonists

It is very uncertain whether tiotropium changes mortality (all‐cause) compared with long‐acting beta‐agonists (very low certainty).

• Tiotropium versus long‐acting beta‐agonists for stable chronic obstructive pulmonary disease 2012 · Cochrane Headline outcomes only
  OR 0.82 [0.6, 1.13]
  6 studies · 12123 participants
  Very low

Tiotropium + LABA/ICS combination vs tiotropium

Tiotropium + LABA/ICS combination showed no clear difference in mortality (all‐cause) compared with tiotropium (moderate certainty).

• Combination inhaled steroid and long‐acting beta₂‐agonist in addition to tiotropium versus tiotropium or combination… 2016 · Cochrane Headline outcomes only
  OR 1.8 [0.55, 5.91]
  2 studies · 961 participants
  Moderate

Aclidinium bromide vs tiotropium

• Aclidinium bromide for stable chronic obstructive pulmonary disease 2014 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 329 participants
  GRADE not reported