COPD
Tiotropium alone (as oral inhalation powder or solution) or tiotropium/olodaterol fixed-combination therapy (as oral inhalation solution): Long-term maintenance treatment of reversible bronchospasm associated with COPD, including chronic bronchitis and emphysema.      
Tiotropium alone (as oral inhalation powder or solution): Reduction of COPD exacerbations in patients with a history of exacerbations. 
A long-acting bronchodilator (e.g., orally inhaled salmeterol, formoterol, tiotropium) or an inhaled corticosteroid recommended for maintenance monotherapy in patients with moderate to severe COPD (e.g., FEV1 30 to <80% of predicted or, alternatively, <60% of predicted) who have persistent symptoms not relieved by as-needed therapy with a selective, short-acting inhaled β2-adrenergic agonist.  Maintenance therapy with long-acting bronchodilators in such patients more effective and more convenient than regular therapy with short-acting bronchodilators.   Insufficient data to favor one maintenance monotherapy over another in patients with moderate to severe COPD.  In selected patients with inadequate response, may use a combination of several long-acting bronchodilators, such as tiotropium, and a long-acting β2-adrenergic agonist. 
In patients with severe to very severe COPD (e.g., FEV1 <30 to <50% of predicted), some clinicians recommend addition of an inhaled corticosteroid to one or more long-acting bronchodilators, given separately or in fixed combination;   however, benefits of combination therapy over monotherapy not consistently established.  If inadequate response or limiting adverse effects occur, may consider the addition or substitution of extended-release oral theophylline.  
Tiotropium alone (as oral inhalation powder or solution) or tiotropium/olodaterol fixed-combination therapy (as oral inhalation solution): Not indicated for initial treatment of acute episodes of bronchospasm or acute deterioration of COPD;   a drug with a more rapid onset of action (e.g., a short-acting β-adrenergic agonist) preferred.   
Asthma
Tiotropium alone (as oral inhalation solution): Long-term maintenance treatment of reversible bronchospasm associated with asthma.
Tiotropium oral inhalation solution: Not indicated for treatment of acute episodes of bronchospasm.
Tiotropium/olodaterol fixed-combination therapy: Not indicated for treatment of asthma.
