الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
The purpose of this study is:
1- To compare the bronchodilator effect of inhaled salbutamol, ipratropium- bromide, ipratropiun- salbutamol combination and tiotropium in patients with stable COPD.
2- To determine the long term effect of these bronchodilator on pulmonary function tests in patients with stable COPD.
This study found that tiotropium provides effective bronchodilation even after 15 minutes of administration and it should prove to be a safe and effective bronchodilator with once-daily dosing in patients with COPD.
Although regular use of bronchodilators can not stop the progressive decline of pulmonary function among patients with COPD, they demonstrate improvement of their symptoms and prevention of exacerbations which are of more come concern to the patients.
We recommend that longer term studies are required to confirm the safety and efficacy of tiotropium as a maintenance bronchodilator for patients with COPD.
As well as COPD is a progressive disease, so we recommended that spirometric testing of at risk persons can help identify patients early in the disease course who may benefit from early intervention to slow the disease process.