The Scottish Medicines Consortium (SMC) has advised NHS Boards and Area Drug and Therapeutic Committees that tiotropium respimat inhaler (Spiriva Respimat) be accepted for restricted use within NHS Scotland as maintenance bronchodilator treatment to relieve symptoms of patients with chronic obstructive pulmonary disease. The SMC adds that it may be used for patients in whom tiotropium is an appropriate choice of maintenance bronchodilator treatment but it is restricted to patients who have poor manual dexterity and therefore have difficulty using the Handihaler device.