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The aim of this double-blind, double-dummy, crossover, randomised, pilot study was to explore the acute effects of adding salmeterol and tiotropium in patients with stable COPD. A total of 20 outpatients with stable COPD were enrolled. Single doses of 18-μg tiotropium, 50-μg salmeterol, and 18-μg tiotropium+50-μg salmeterol were given. Serial measurements of forced expiratory volume in 1s (FEV₁) were performed over 24h. The mean maximum increases in FEV₁ from pre-dosing value on each of the dosing days were 0.165l (95% CI: 0.098–0.232) for tiotropium, 0.241l (95% CI: 0.151–0.332) for salmeterol, and 0.290l (95% CI: 0.228–0.353) for the combination and occurred 4h after inhalation of tiotropium or salmeterol and 3h after the combination. At 12h, the mean increases in FEV₁ from pre-dosing value were 0.071l (95% CI: 0.001–0.141; P=0.047) for tiotropium, 0.069l (95% CI: 0.018-0.120; P=0.010) for …