IL157326A - Pharmaceutical compositions containing tiotropium salts and pde-iv inhibitor, optionally in the form of inhalable powders, propellant-containing inhalable aerosols and inhalable solutions or suspensions comprising said compositions - Google Patents

Description

157326/3 mm >τη>Ί_» wa PDE IV∞»m tjamw>> tt ΑβΝΠ»η m mnp > ¾>->n Λΐηρη wan *)>ηΐΛ w ν.»™ na>N¾>t> ^W N 1»3»η *>τι τ> ,7ΐο>Νν!7 npaN Pharmaceutical compositions containing tiotropium salts and PDE-IV inhibitor, optionally in the form of an inhalable, powders, propellant-containing inhalable aerosols, and inhalable solutions or suspensions comprising said composition Boehringer Ingelheim Pharma GmbH & Co. KG C.146736 157326/3 1 The present invention related to novel pharmaceutical composition based on anticholinerdics and PDE-IV inhibitors, processes for preparing them and their use in the treatment of respiratory diseases.

Summary of the invention The present invention directed to a pharmaceutical composition characterized in that it contains one or more tiotropium salts (1) combined with one or more PDR-IV inhibitors (2), optionally in the form of the enantiomers, mixure of the enantiomers or in the form of the racemantes thereof, optionally in the form of the solvates or hydrates and optionally together with a pharmaceutically acceptable excipient.

The present invention further directed to an inhalable powder, characterized in that the excipient has maximum average particle size of up to 250μπι, preferably between 10 and 150 μιη.

The present invention further directed to a capsules, characterized in that they contain an inhalable powder.

The present invention further directed to a pharmaceutical composition according to the invention characterized in that it is an inhalable powder, which contain only the active substance 1 and 2 as its ingredients.

The present invention further directed to a pharmaceutical composition according to the invention characterized in that it is a propellant containing inhalable aerosol which contains 1 and 2 in dissolved or dispersed form.

The present invention further directed to propellant containing inhalable aerosol according to the invention, characterizes in that it contains as propellant gas, hydrocarbons such as n-propane, n-butane or isobutene or haloydrocarbons such as chlorinated and/or fluorinated derivatives of methane, ethane, propane, butane, cyclopropane or cyclobutan.

The present invention further provides for a inhalable solution or suspension according to the invention, characterized in that it is the PH is 2-7, preferable 2-5. 01467364X53-01 157326/1 la The present invention further provides for an inhalable solution or suspension according to the invention, characterized in that it is the PH is adjusted by means of an acid selected fro among hydrochloric acid, hydrobromic acid, nitric acid, sulphuric acid, ascorbic acid, citric acid, malic acid, acetic acid, maleic acid, succinic acid, fumaric acid, acetic acid, formic acid and propionic acid or mixture thereof.

The present invention further provides for an inhalable solution or suspension according to the invention, characterized in that it is optionally contains other co-solvent and/or excipients.

The present invention further provides for a use of a composition according to the invention for preparing a medicament for treating inflammatory or obstructive diseases of the respiratory tract.

Background of the invention EPO 104829b provides for an improved drilling fluids based on a mixture of a sulfonated thermoplastic polymer and a sulfonated elastomeric polymer.

US6069163A provides for an azapeptide acids of Formula I are antagonists of VLA-4 and/or alpha 4 beta 7, and as such are useful in the inhibition or prevention of cell adhesion and cell-adhesion mediated pathologies. These compounds may be formulated into pharmaceutical compositions and are suitable for use in the treatment of asthma, allergies, inflammation, multiple sclerosis, and other inflammatory and autoimmune disorders.

Bernd Disse et al "Tiotropium (Spriv A1"1): Mechanistical Considerations And Clinical Profile In Obstructive Lung Disease" Life Science, Vol 64, Nos 6/7 P. 457-464, 199, discloses tiotropium for treating COPD.

Marry S. Barnette: "Phosphodiesterase 4 (PDE4) inhibitors in asthma and chronic obstructive pulmonary disease (COPD)" progress in drug research, Vol 53, 1999 discloses the review of evidence demonstrating the ability of way remodeling and hyperactivity, presenting some preliminary findings obtained with theses compounds in clinical trials and discusses experimental 01467364\53-01 157326/1 lb approaches designed to identify novel compounds that maintain the beneficial activity of the initial selective PDE4 inhibitors but with reduces tendency to elicit the gastrointestinal side effects observed with this class of compounds.

NISHIMURA KOICHI ET AL: "Additive effect of oxitropium bromide in combination with inhaled corticosteroids in the treatment of elderly patients with chronic asthma." ALLERGOLOGY INTERNATIONAL, Bd. 48, Nr. 1, Marz 1999 (1999-03), Seiten 85-88, XP001070756 ISSN: 1323-8930, discloses that the addition of regular inhalation of oxitropium bromide is beneficial in elderly asthmatics whose asthma is not well controlled, even when treated with high-dose inhaled steroids.

THEODORE J. TORPHY et al. " SB 207499 (Ariflo), a Potent and Selective Second-Generation Phosphodiesterase 4 Inhibitor: In Vitro Anti-inflammatory Actions" THE JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS Vol. 284, No. 1 JPET 284:420-426, 1998, discloses the comparison of the anti-inflammatory and gastric secretogogue activities of SB 207499 with those of rolipram. The cellular models used were (1) histamine release from human basophils, (2) tumor necrosis factor-a generation in human monocytes, (3) degranulation of human neutrophils, (4) antigendriven proliferation and cytokine synthesis from human T cells and (5) acid secretion from isolated rabbit gastric glands. SB 207499 inhibited the activation of a variety of immune and inflammatory cells in a concentration-dependent manner: (1) histamine release in basophils [21og IC25 5 6.6 6 0.3 vs. 8.0 for (i?)-rolipram], (2) lipopolysacchride-induced TNF-a formation in monocytes [21og IC50 5 7.0 6 0.1 vs. 7.2 6 0.1 for (R)- rolipram], (3) fMLP-induced degranulation in neutrophils [2log IC15 5 7.1 6 0.2 vs. 6 A 6 0.5 for (i?)-rolipram], (4) house dust mite induced-proliferation of peripheral blood mononuclear cells [21og IC40 5 6.5 6 0.3 vs. 6.4 6 0.3 for (2?)-rolipram] and (5) ragweed-induced production of interferon-g [21og IC50 5 5.4] and interleukin-5 [21og IC50 5 5.0]. Although SB 207499 inhibits the activation of a variety of immune and inflammatory cells with a potency equal to that of 01467364\53-01 , 157326/1 lc rolipram, it is .100-fold less potent than the latter compound as an acid secretagogue [21og EC50 5 6.1 6 0.1 TO.8.3 6 0.2 for (tf)-rolipram]. Collectively, these data indicate that SB 207499 retains the anti-inflammatory activity of the prototypical PDE4 inhibitor rolipram but is substantially less likely to stimulate gastric acid secretion Descript ion of the invention The present invention relates to Pharmaceutical composition characterized in that it contains one or more tiotropium salts (1) combined with one or more PDE-IV inhibitors (2), optionally in the form of the enantiomers, mixtures of the enantiomers or in the form of the racemates thereof, optionally in the form of the solvates or hydrates and optionally together with a pharmaceutically acceptable excipient.

Surprisingly, an unexpected beneficial therapeutic effect, particularly a synergistic effect can be observed using the pharmaceutical compositions of the present application for manufacturing medicament for treating inflammatory and/or obstructive diseases of the respiratory tract in case one or more tiotropium salts are combined with one or more . PDE-IV inhibitors. In view of this, synergistic effect, the pharmaceutical combinations according to the invention can be used in smal ler doses than would be the case wi th the individual compounds used in monotherapy in the usual way . Furthermore , this reduces unwanted side ef f ects such as may occur when PDE - IV inhibitors are adminis tered , f or example .

The ef fects mentioned, above may be observed both when the^ two active subs tances are adminis tered simul taneously in' a s ingle active substance formulation and when they are administered succes sively in separate f ormulations .

According to , the invent ion , it is' preferable to administer the two active subs tance ingredient s s imul taneously in a . singl e f ormulat ion . 157326/2 Within the scope of the present invention the term anticholinergics 1 denotes salts which are preferably selected from among tiotropium salts, oxitropium salts and ipratropium salts, most preferably ipratropium salts and tiotropium salts. In the above-mentioned salts the cations tiotropium, oxitropium and ipratropium are the pharmacologically active ingredients. Within the scope of the present patent application, any reference to the above cations is indicated by the use of the number 1' . Any reference to compounds 1 naturally also includes a reference to the ingredients (tiotropium, oxitropium or ipratropium) .

By the salts 1 which may be used within the scope of the present invention are meant the compounds which contain, in addition to tiotropium, oxitropium or ipratropium as counter-ion (anion) , chloride, bromide, iodide, methanesulphonate or para- toluenesulphonate . Within the scope of the present invention, the methanesulphonate, chloride, bromide and iodide are preferred of all the salts 1, the methanesulphonate and bromide being of particular importance. Of outstanding importance according to the invention are salts 1 selected from among tiotropium bromide, oxitropium bromide and ipratropium bromide. Tiotropium bromide is particularly preferred.

The pharmaceutical composition according to the present invention may be in the form selected from among inhalable powders, propellant-containing metering aerosols and propellant-free inhalable solutions or suspensions.

Within the scope of the present invention, the word PDE-IV inhibitors (hereinafter 2) denotes compounds selected from among enprofylline, roflumilast, ariflo, Bay-198004, CP-325,366, BY343, D-4396 (Sch-351591) , V-11294A, AWD-12-281 and the tricyclic nitrogen heterocycles of general formula 2a denotes Ci-Cs-alkyl, Cs-Cg-cycloalkyl, phenyl, benzyl or a 5- or 6-membered, saturated or unsaturated heterocyclic ring which may contain one or two heteroatoms selected from among oxygen and nitrogen; denotes Ci-Cs-alkyl or C2~C4-alkenyl ; denotes C^-Cs-alkyl which may optionally be substituted by C^-C^alkoxy, Cs-Cg-cycloalkyl, phenoxy or a 5- or 6-membered, saturated or unsaturated heterocyclic ring which may contain one or two heteroatoms selected from among oxygen and nitrogen; C5-Cg-cycloalkyl or phenyl or benzyl optionally substituted by Ci~C4-alko y, optionally in the form of their racemates, their enantiomers, in the form of the diastereomers and the mixtures thereof, optionally in the form of their tautomers and optionally the pharmacologically acceptable acid addition salts thereof.

Of the abovementioned compounds of 2a those which are preferably used within the scope of the present invention are those compounds of formula 2a wherein R1 denotes Ci-C -alkyl, Cs-Cg-cycloalkyl , tetrahydrofuranyl , tetrahydropyranyl , piperazinyl, morpholinyl or phenyl; R2 denotes C]_-C4-alk l or C2~C4-alkenyl ; R3 denotes C^-C^j-alkyl which may optionally be substituted by C1-C4-alkoxy, Cs-Cg-cycloalkyl , phenoxy, (Ci-Cj-alkoxy) phenyloxy, piperazine or pyrrole, C5 -Cg-cycloalkyl or phenyl or benzyl optionally substituted by C^-C^alkoxy, optionally in the form of their racemates, their enantiomers, in the form of the diastereomers and the mixtures thereof, optionally in the form of their tautomers and optionally the pharmacologically acceptable acid addition salts thereof .

Of the compounds of formula 2a those which are most preferably used within the scope of the present invention are those compounds of formula 2a wherein R1 denotes ethyl, propyl, butyl, cyclopentyl , tetrahydrofuranyl , tetrahydropyranyl , N- morpholinyl or phenyl; R2 denotes ethyl, propyl, allyl or butenyl; R3 denotes ethyl, propyl, butyl, cyclopentyl, cyclohexylmethyl , benzyl, phenylethyl, phenoxymethyl , methoxybenzyl or N-pyrolylmethyl , optionally in the form of their racemates, their enantiomers, in the form of the diastereomers and the mixtures thereof, optionally in the form of their tautomers and optionally the pharmacologically acceptable acid addition salts thereof .

Most preferably, the compounds used as component 2 are the compounds of formula 2a wherein R1 denotes ethyl, n-propyl, tert -butyl, cyclopentyl, 3 -tetrahydrofuryl , N-morpholinyl or phenyl ; R2 denotes ethyl or n-propyl; R3 denotes ethyl, i-propyl, n-propyl, n-butyl, t- butyl, cyclopentyl, cyclohexylmethyl , benzyl, phenylethyl, phenoxymethyl , 4-methoxybenzyl or N-pyrollylmethyl , optionally in the form of their racemates, their enantiomers, in the form of the diastereomers and the mixtures thereof, optionally in the form of their tautomers and optionally the pharmacologically acceptable acid addition salts thereof.

Examples of alkyl groups (including those which are part of other groups) are branched and unbranched alkyl groups with 1 to 5 carbon atoms, such as, for example: methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec. butyl, tert. butyl, n-pentyl, isopentyl or neopentyl . The abbreviations Me, Et, n-Pr, i-Pr, n-Bu, i-Bu, t-Bu, etc. may optionally be used for the abovementioned groups.

Examples of cycloalkyl groups with 5 or 6 carbon atoms include cyclopentyl or cyclohexyl. Examples of 5- or 6-membered, saturated or unsaturated heterocyclic rings which may contain one or two heteroatoms selected from among oxygen and nitrogen include: furan, tetrahydrofuran, tetrahydrofuranone, γ-butyrolactone, a-pyran, γ-pyran, dioxolane, tetrahydropyran, dioxane, pyrrole, pyrroline, pyrrolidine, pyrazole, pyrazoline, imidazole, imidazoline, imidazolidine, pyridine, piperidine, pyridazine, pyrimidine, pyrazine, piperazine, morpholine, oxazole, isoxazole, oxazine and pyrazolidine .

Table 1 lists the compounds of general formula 2a are most preferably used in conjunction with the compounds 1 within the scope of the invention.

Table 1: The compounds of general formula 2a may be prepared analogously to the method described in the prior art for certain of the above-defined compounds of general formula (I) (Tenor et al . , Chem. Ber. Vol. 97 (1964) p. 1373- 1382), to which reference is hereby made.

Preferably, also, the compound 2 is selected from among enprofylline, roflumilast, ariflo and AWD-12-281, while AWD-12-281 and the abovementioned compounds of formula 2a are particularly preferred as compound 2 according to the invention .

Any reference to the abovementioned PDE-IV inhibitors 2 within the scope of the present invention includes a reference to any pharmacologically acceptable acid addition salts thereof which may exist.

By the physiologically acceptable acid addition salts which may be formed from 2 are meant, for example, pharmaceutically acceptable salts selected from the salts of hydrochloric acid, hydrobromic acid, sulphuric acid, phosphoric acid, methanesulphonic acid, acetic acid, fumaric acid, succinic acid, lactic acid, citric acid, tartaric acid or maleic acid. Particularly preferred salts of the compounds 2 according to the invention are those selected from among the acetate, hydrochloride, hydrobromide, sulphate, phosphate and methanesulphonate .

The pharmaceutical combinations of 1 and 2 according to the invention are preferably administered by inhalation. Suitable inhalable powders packed into suitable capsules (inhalettes) may be administered using suitable powder inhalers. Alternatively, the drug may be inhaled by the application of suitable inhalation aerosols. These also include inhalation aerosols which contain HFA134a (also known as TG134a) , HFA227 (also known as TG227) or a mixture thereof as propellant gas. The drug may also be inhaled using suitable solutions of the pharmaceutical combination consisting of 1 and 2.

In one aspect, therefore, the invention relates to a pharmaceutical composition which contains a combination of 1 and 2.

In another aspect the present invention relates to a pharmaceutical composition which contains one or more salts 1 and one or more compounds 2, optionally in the form of their solvates or hydrates. Again, the active substances may be combined in a single preparation or contained in two separate formulations. Pharmaceutical compositions which contain the active substances 1 and 2 in a single preparation are preferred according to the invention .

In another aspect the present invention relates to a pharmaceutical composition which contains, in addition to therapeutically effective quantities of 1 and 2, a pharmaceutically acceptable excipient. In another aspect the present invention relates to a pharmaceutical composition which does not contain any pharmaceutically acceptable excipient in addition to therapeutically effective quantities of 1 and 2.

The present invention also relates to the use of 1 and 2 for preparing a pharmaceutical composition containing therapeutically effective quantities of 1 and 2 for treating inflammatory and/or obstructive diseases of the respiratory tract, particularly asthma or chronic obstructive pulmonary disease (COPD) , and complications thereof such as pulmonary hypertension, as well as allergic and non-allergic rhinitis.

The present invention also relates to the simultaneous or successive use of therapeutically effective doses of the combination of the above pharmaceutical compositions 1 and 2 for treating inflammatory and/or obstructive diseases of the respiratory tract, particularly asthma or chronic obstructive pulmonary disease (COPD) , and complications thereof such as pulmonary hypertension, as well as allergic and non-allergic rhinitis, by-simultaneous or successive administration.

In the active substance combinations of 1 and 2 according to the invention, ingredients 1 and 2 may be present in the form of their enantiomers, mixtures of enantiomers or in the form of racemates .

The proportions in which the two active substances 1 and 2 may be used in the active substance combinations according to the invention are variable. Active substances 1 and 2 may possibly be present in the form of their solvates or hydrates. Depending on the choice of the compounds 1 and 2, the weight ratios which may be used within the scope of the present invention vary on the basis of the different molecular weights of the various compounds and their different potencies. As a rule, the pharmaceutical combinations according to the invention may contain compounds 1 and 2 in ratios by weight ranging from 1:300 to 50:1, preferably from 1:250 to 40:1. In the particularly preferred pharmaceutical combinations which contain tiotropium salt as compound 1, the weight ratios of 1 to 2 are most preferably in a range in which ipratropium or tiotropium and 2 are present in proportions of 1:150 to 30:1, more preferably from 1:50 to 20:1.

For example, without restricting the scope of the invention thereto, preferred combinations of 1 and 2 according to the invention niay contain tiotropium and .

PDE-IV inhibitor 2 in the following weight ratios: 1:80, 1:79, 1:78, 1:77, 1:76, 1:75, 1:74, 1:73, 1:72, 1:71, 1:70, 1:69, 1:68, 1:67, 1:66, 1:65, 1:64, 1:63, 1:62, 1:61, 1:60, 1:59, 1:58, 1:57, 1:56, 1:55, 1:54, 1:53, 1:52, 1:51, 1:50; 1:49; 1:48; 1:47; 1:46; 1:45; 1 : 44; 1:43; 1 : 42; 1: 41; 1:40; 1.39; 1:38; 1 : 37; 1 :36; 1 : 35; 1:34; 1 : 33 ; 1 : 32; 1:31; 1 30; 1:29; 1 : 28; 1 :27; 1 : 26; 1:25; 1 : 24; 1 : 23; 1:22; 1 21; 1:20; 1 : 19; 1 :18; 1 : 17; 1:16; 1 : 15; 1 : 14; 1:13; 1 12; 1:11; 1 : 10; 1 :9; 1:8; 1 : 7; 1:6; 1 :5; 1 : 4; 1:3; 1:2; 1 1; 2:1; 3 :1 4 : 1; 5:1; 6: i; 7:1; 8 :i; 9 : 1/ 10:1; 11: 1; 12 : 1; 13: i; 14 : l; 15:1; 16 :i; 17:1; 18 :1; 19 :1; 20:1.

The pharmaceutical compositions according to the invention containing the combinations of 1 and 2 are normally administered so that 1 and 2 are present together in doses of 0.01 to 10000 g, preferably from 0.1 to 2000 gJ more preferably from 1 to 1500 g, better still from 50 to 1200μg per single dose. For example, combinations of 1 and 2 according to the invention contain a quantity of tiotropium 1_ and PDE-IV inhibitor 2 such that the total dosage per single dose is about 100μg, 105μg( 110μg, 115μg, 120μg, 125μg> 130μg, 135μ5, 140^g, 145 g 150 g, 155 g, 160 g, 165μg< 170μgί 175 g, 180/ig, 185 g, 190 g, 195 g, 200μg, 205 g( 2^g, 215 g, 220^g, 225 g( 230 g, 235 g, 240 g, 245μg) 250μgί 255 g; 260/*g, 265μg, 270 gί 2Ί5μ<3, 280μg, 285 gί 290 g, 295μ<3, 300xg, 305μς, 310 g, 315 g, 320 g, 325μg) 330 g> 335 g, 340 g, 345μg, 350μ3, 355 g, 360 g, 365 g, 370μg, 380//g, 385 g, 390 g> 95μ<3, 400 g, 405 gί 4^g, 415 g 20μg> 425 g, 430 g, 435 9, 440μg/ 45 g/ 450μg, 455 g, 460^g, 465 g> 470 g, 475 g 480μg> 485μg 490μg/ 495 g, 500^g, 505 g> 510 g, 515 g, 520 g, 525μg, 530μg, 535 g; 0μg, 545μg/ 550μgί 555μg, 560μg, 565μgί 570μg/ 575μg, 580μg, 585μg> 590μg, 595μg) 600μg( 605μg, 6^g, 615μg( 620μg( 625μg 630μg, 635μg) 640μg( 645μg/ 650 g> 655 g, 660μg, 665μg, 670μg, 675μg, 680μg) 685μg, 690μg, 695μg( 700μg) 705μgί 710μgί 715μg, 720μg, 725μg; 730μg, 735μg, 740μg( 745μg 750μg, 755μ9, 760μg, 765μg, 770μg( 775μ9; 780μg, 785μgί 790 g, 795μ5( 800μg, 805μg< 810μg, 815μgί 820μg( 825μg/ 830μg, 835μg, 840μg, 845μg, 850μg, 855 g; 8β0μ9, 865μg, 87C^g, 875μg, 880μ9, 885 , 89C^g, 895μ , 900μ , 905μ , 910μ , 915μ , 920μ , 925μ , 930μ , 935μ , 940μ9, 9 5μ , 950 , 955μ , 960μ , 965μ , 970μ , 975μ , 980μ , 985μ , 990μ , 995μ , 1000μ , 1005μ9, 1010μ , lO^ig, 1020μ , 1025μ , 1030μ , 1035 9, 1040μ9, 1045μ , 1050μ , 1055μ , 1060μ9, 1065μ9, 1070μ , 1075 9, 1080μ , 1085ng, 1090μ , 1095μ , 1100μ or similar. The suggested dosages per single dose specified above are not to be regarded as being limited to the numerical values actually stated, but are intended as dosages which are disclosed by way of example. Of course, dosages which may fluctuate about the abovementioned numerical values within a range of about +/- 2.5 g are also included in the values given above by way of example. In these dosage ranges, the active substances and 2 may be present in the weight ratios given above.

For example, without restricting the scope of the invention thereto, the combinations of 1 and 2 according to the invention may contain a quantity of tiotropium lj_ and PDE-IV inhibitor 2 such that, for each single dose, 5^g of and 25ig of 2, 5^g of and 50 g of 2, 5μg of 1' and 100μg of 2, 5^g of and 200 g of 2, 5^g of and 300μ<3 of 2, 5^g of and 400 g of 2, 5 g of and 500μg of 2, 5μg of and 600μ9 of 2, 5 g of and 700 g of 2, of and 800μg of 2, 5 g of and 900 g of 2, g of and 1000μg of 2, 10μg of and 25μg of 2, g of 1J_ and 50μg of 2, 10μg of 1_ and 100μg of 2, 10 g of _ and 200μg of 2, 10μg of and 300μg of 2, 10μ of 1' and 400μg of 2, 10μg of and 50(^g of 2, 10μg of and 600μ9 of 2, 10μg of and 700μg of 2, 10μg of and 800μg of 2, 10ig of 3J_ and 900μg of 2, 10μ of and 1000 g of 2, 18 g of and 25μg of 2, 18 g of and 50μg of 2, 18μg of and 100μ9 of 2, 18μg of and 200 g of 2, 18μg of 1 _ and 300μg of 2, 18μg of and 400 g of 2, 18μg of 1J_ and 500μg of 2, 18μ of and 60(^g of 2, 18μg of and 700 g of 2, 18/xg of and 800μg of 2, 18^g of and 90(^g of 2, 18μg of 1_ and lOOO^g of 2, 2C^g of and 25 g of 2, 20^g of and 50μg of 2, 20μg of and 50μg of 2, 20μg of and lOC^g of 2, 20μg of and 200μg of 2, 20μg of and 30(^g of 2, 20μg of and 400μg of 2, 2C^g of and 500μg of 2, 20μg of 1_ and 60C^g of 2, 20μg of and 700μg of 2, 20μg of and 80C^g of 2, 20μg of and 900μg of 2, 2C^g of and 1000 g of 2, 36μg of and 25μg of 2, 36μg of and 50μg of 2, 36μg of and lOC^g of 2, 36 g of and 200μg of 2, 36 g of and 30C^g of 2, 36 g of 1' and 400μg of 2, 36 g of and 500μg of 2, 36μg of 1' and 60(-^g of 2, 36μg of and 700μg of 2, 36μg of and 80C^g of 2, 36μg of and 900μg of 2, 36μg of and lOOC^g of 2, 40 g of and 25μg of 2, 4C^g of and 50μg of 2, 40μg of and lOC^g of 2, 40μg of and 200μg of 2, 40μg of and 30C^g of 2, 40μg of and 400μg of 2, 4(^g of and 500μg of 2, 0 g of and 60C^g of 2 or 4C^g of and 700μg of 2, 40μg of and 800μg of 2, 40μg of and 900μg of 2, 40μg of and 1000μg of 2 are administered.

If the active substance combination in which 1 denotes tiotropium bromide is used as the preferred combination of 1 and 2 according to the invention, the quantities of active substance and 2 administered per single dose mentioned by way of example correspond to the following quantities of 1 and 2 administered per single dose: 6 g of 1 and 25μg of 2, 6μg of 1 and 50μg of 2, 6μg.of 1 and 100μg of 2, 6μg of 1 and 200μg of 2, 6μg of 1 and 300μg of 2, 6 g of 1 and 400 g of 2, 6μg of 1 and 500μg of 2, 6μg of 1 and 600μg of 2, 6μg of 1 and 700μg of 2, β g of 1 and 800μg of 2, 6μg of 1 and 900μg of 2, 6μg of 1 and 1000μg of 2, 12μg of 1 and 25μg of 2, 12μg of 1 and 50μg of 2, 12 g of 1 and 100μg of 2, 12μg of 1 and 200μg of 2, 12μg of 1 and 300μg of 2, 12μg of 1 and 400μg of 2, 12 g of 1 and 500zg of 2, 12^g of 1 and 60C^g of 2, 12μg of 1 and 700μg of 2, 12μg of 1 and 80C^g of 2, 12^g of 1 and 900μg of 2, 12μg of 1 and 1000/xg of 2, 21.7μg of 1 and 25 g of 2, 21.7 g of 1 and 50 g of 2, 21.7 g of 1 and lOC^g of 2, 21.7μg of 1 and 200μg of 2, 21.7μg of 1 and 30C^g of 2, 21.7μg of 1 and 400μg of 2, 21.Ίμ<3 of 1 and 500μg of 2, 21.7μg of 1 and 60C^g of 2, 21.7μg of 1 and 700 g of 2, 21.7 g of 1 and 80(^g of 2, 21.7 g of 1 and 900μg of 2, 21.Ίμ<3 of 1 and 1000μg of 2, 24. lμg of 1 and 25μg of 2, 24. ^g of 1 and 50μg of 2, 24.1μg of 1 and (^g of 2, 24.1μg of 1 and 200μg of 2, 24.1μg of 1 and 3C^g of 2, 24.1μg of 1 and 400μg of 2, 24. l^g of 1 and 50C^g of 2, 24.1μg of 1 and 600μg of 2, 24.1μg of 1 and 70C^g of 2, 24.1μg of 1 and 800 g of 2, 24. ^g of 1 and 90C^g of 2, 24.1μg of 1 and 1000μg of 2, 43^g of 1 and 25μg of 2, 43.3μg of 1 and 5<-^g of 2, 43.3μg of 1 and 100μg of 2, 43.3μg of 1 and 20(_^g of 2, 43.3μg of 1 and 300μg of 2, 43.3μ^ of 1 and 400 g of 2, 43.3μg of 1 and 50(^g of 2, 43.3μg of 1 and 600μg of 2, 43.3μg of 1 and 700μg of 2, 43.3μg of 1 and 800 g of 2, 43.3μg of 1 and 900μg of 2, 3.3 g of 1 and 1000μg of 2, 48. ^g of 1 and 25μg of 2, 48.1μg of 1 and 50μg of 2, 48.1μg of 1 and 100μg of 2, 8.1μg of 1 and 200μg of 2, 48.1 g of 1 and 300μg of 2, 48. ^g of 1 and 400μg of 2, 48.1μg of 1 and 500 g of 2, 48. ^g of 1 and 600μg of 2, 8.1μg of 1 and 700μg of 2, 48.1μg of 1 and 800μg of 2, 48.1 g of 1 and 900μg of 2, 8.1μg of 1 and 1000μg of 2.

If the active substance combination in which 1 is tiotropium bromide monohydrate is used as the preferred combination of 1 and 2 according to the invention, the quantities of and 2 administered per single dose specified by way of example hereinbefore correspond to the following quantities of 1 and 2 administered per single dose: 6.2 g of 1 and 25μg of 2, 6.2 g of 1 and 50ug of 2, 6.2ug of 1 and lOO^g of 2, 6.2μg of 1 and 200ug of 2, 6.2μg of 1 and 300μg of 2, 6.2 g of 1 and 400μg of 2, 6.2μg of 1 and 50C^g of 2, 6.2μg of 1 and β00μg of 2, 6.2μg of 1 and 700/ig of 2, 6.2μg of 1 and 800μg of 2, 6.2μg of 1 and 90C^g of 2, 6.2μg of 1 and 1000μg of 2, 12^g of 1 and 25μg of 2, 12.5μg of 1 and 5<_^g of 2, 12.5 g of 1 and 100 g of 2, 12.5μg of 1 and 20(^g of 2, 12.5μg of 1 and 300μg of 2, 12.5μg of 1 and 400μg of 2, 12.5 g of 1 and 50C^g of 2, 12.5μg of 1 and 600μg of 2, 12.5μg of 1 and 70C^g of 2, 12.5μg of 1 and 800μg of 2, 12.5μg of 1 and 90(^g of 2, 12.5 g of 1 and 1000μg of 2, 22.5μg of 1 and 25μg of 2, 22.5 g of 1 and 5(_^g of 2, 22.5μg of 1 and 100μg of 2, 22.5μg of 1 and 20(^g of 2, 22.5μg of 1 and 300μg of 2, 22^g of 1 and 40C^g of 2, 22.5μg of 1 and 500μg of 2, 22.5μg of 1 and 600μg of 2, 22.5μg of 1 and 70C^g of 2, 22.5 g of 1 and 800μg of 2, 22.5μg of 1 and 90C^g of 2, 22.5μg of 1 and 1000μg of 2, 25μg of 1 and 25μg of 2, 25μg of 1 and 5(^g of 2, 25μg of 1 and 100μg of 2, 25μg of 1 and 20(^g of 2, 25μg of 1 and 300μg of 2, 25 g of 1 and 400μg of 2, 25μg of 1 and 500μg of 2, 25μg of 1 and 600μg of 2, 25 g of 1 and 700μg of 2, 25μg of 1 and 800μg of 2, 25 g of 1 and 900μg of 2, 25μg of 1 and 1000μg of 2, 45μg of 1 and 25μg of 2, 45μg of 1 and 50μg of 2, 45μg of 1 and 100μg of 2, 45 g of 1 and 200μg of 2, 45μg of 1 and 300μg of 2, 45 g of 1 and 400μg of 2, 45μg of 1 and 500μg of 2, 45μg of 1 and 600μg of 2, 45μg of 1 and 700μg of 2, 45μg of 1 and 800μg of 2, 45μg of 1 and 900μg of 2, 45μg of 1 and 1000μg of 2, 50 g of 1 and 25 g of 2, 50μg of 1 and 50 g of 2, 50 g of 1 and 100μg of 2, 50μg of 1 and 200μg of 2, 50μg of 1 and 300μg of 2, 50μg of 1 and 400μg of 2, 50μg of 1 and 500μg of 2, 50μg of 1 and 600μg of 2, 50μg of 1 and 700μg of 2, 50μg of 1 and 800μg of 2, 50 g of 1 and 900μg of 2 or 50μg of 1 and 1000μg of 2.

The active substance combinations of 1 and 2 according to the invention are preferably administered by inhalation. For this purpose, ingredients 1 and 2 have to be made available in forms suitable for inhalation. Inhalable preparations include inhalable powders, propellant- containing metering aerosols or propellant-free inhalable solutions. Inhalable powders according to the invention containing the combination of active substances 1 and 2 may consist of the active substances on their own or of a mixture of the active substances with physiologically acceptable excipients . Within the scope of the present invention, the term propellant-free inhalable solutions also includes concentrates or sterile inhalable solutions ready for use. The preparations according to the invention may contain the combination of active substances 1 and 2 either together in one formulation or in two separate formulations. These formulations which may be used within the scope of the present invention are described in more detail in the next part of the specification.

A) Inhalable powder containing the combinations of active substances 1 and 2 according to the invention: The inhalable powders according to the invention may contain 1 and 2 either on their own or in admixture with suitable physiologically acceptable excipients.

If the active substances 1 and 2 are present in admixture with physiologically acceptable excipients, the following physiologically acceptable excipients may be used to prepare these inhalable powders according to the invention: monosaccharides (e.g. glucose or arabinose) , disaccharides (e.g. lactose, saccharose, maltose), oligo-and polysaccharides (e.g. dextran) , polyalcohols (e.g. sorbitol, mannitol, xylitol) , salts (e.g. sodium chloride, calcium carbonate) or mixtures of these WO 02/069945 - 16 - PCT/EP02/O1988 excipients with one another. Preferably, mono- or disaccharides are used, while the use of lactose or glucose is preferred, particularly, but not exclusively, in the form of their hydrates. For the purposes of the invention, lactose is the particularly preferred excipxent, while lactose monohydrate is most particularly preferred .

Within the scope of the inhalable powders according to the invention the excipients have a maximum average particle size of up to preferably between 10 and 150μτη, most preferably between 15 and 80μτη. It may sometimes seem appropriate to add finer excipient fractions with an average particle size of 1 to 9μπι to the excipient mentioned above. These finer excipients are also selected from the group of possible excipients listed hereinbefore. Finally, in order to prepare the inhalable powders according to the invention, micronised active substance 1 and 2, preferably with an average particle size of 0.5 to ΙΟμπι, more preferably from 1 to 5μτη, is added to the excipient mixture. Processes for producing the inhalable powders according to the invention by grinding and micronising and by finally mixing the ingredients together are known from the prior art . The inhalable powders according to the invention may be prepared and administered either in the form of a single powder mixture which contains both 1 and 2 or in the form of separate inhalable powders which contain only 1 or 2.

The inhalable powders according to the invention may be administered using inhalers known from the prior art.

Inhalable powders according to the invention which contain a physiologically acceptable excipient in addition to 1 and 2 may be administered, for example, by means of inhalers which deliver a single dose from a supply using a measuring chamber as described in US 4570630A, or by other means as described in DE 36 25 685 A. Preferably, the inhalable powders according to the invention which contain physiologically acceptable excipient in addition to 1 and 2 are packed into capsules (to produce so-called inhalettes) which are used in inhalers as described, for example, in WO 94/28958.

A particularly preferred inhaler for using the pharmaceutical combination according to the invention in inhalettes is shown in Figure 1.

This inhaler (Handyhaler) for inhaling powdered pharmaceutical compositions from capsules is characterised by a housing 1 containing two windows 2, a deck 3 in which there are air inlet ports and which is provided with a screen 5 secured via a screen housing 4, an inhalation chamber 6 connected to the deck 3 on which there is a push button 9 provided with two sharpened pins 7 and movable counter to a spring 8, and a mouthpiece 12 which is connected to the housing 1, the deck 3 and a cover 11 via a spindle 10 to enable it to be flipped open or shut .

If the inhalable powders according to the invention are packed into capsules (inhalettes) for the preferred use described above, the quantities packed into each capsule should be 1 to 30mg, preferably 3 to 20mg, more particularly 5 to lOmg of inhalable powder per capsule. These capsules contain, according to the invention, either together or separately, the doses of and 2 mentioned hereinbefore for each single dose.

B) Propellant gas -driven inhalation aerosols containing the combinations of active substances 1 and 2: Inhalation aerosols containing propellant gas according to the invention may. contain substances 1 and 2 dissolved in the propellant gas or in dispersed form. 1 and 2 may be present in separate formulations or in a single preparation, in which 1 and 2 are either both dissolved, both dispersed or only one component is dissolved and the other is dispersed. The propellant gases which may be used to prepare the inhalation aerosols according to the invention are known from the prior art . Suitable propellant gases are selected from among hydrocarbons such as n-propane, n-butane or isobutane and halohydrocarbons such as preferably fluorinated derivatives of methane, ethane, propane, butane, cyclopropane or cyclobutane. The propellant gases mentioned above may be used on their own or in mixtures thereof. Particularly preferred propellant gases are halogenated alkane derivatives selected from TG134a, TG227 and mixtures thereof.

The propellant-driven inhalation aerosols according to the invention may also contain other ingredients such as co-solvents, stabilisers, surfactants, antioxidants, lubricants and pH adjusters. All these ingredients are known in the art .

The inhalation aerosols containing propellant gas according to the invention may contain up to 5 wt.-% of active substance 1 and/or 2. Aerosols according to the invention contain, for example, 0.002 to 5 wt.-%, 0.01 to 3 wt.-%, 0.015 to 2 wt.-%, 0.1 to 2 wt.-%, 0.5 to 2 wt.-% or 0.5 to 1 wt.-% of active substance 1 and/or 2.

If the active substances 1 and/or 2 are present in dispersed form, the particles of active substance preferably have an average particle size of up to ΙΟμπι, preferably from 0.1 to 5μπι, more preferably from l to 5μιη.

The propellant-driven inhalation aerosols according to the invention mentioned above may be administered using inhalers known in the art ( DIs = metered dose inhalers) . Accordingly, in another aspect, the present invention relates to pharmaceutical compositions in the form of propellant-driven aerosols as hereinbefore described combined with one or more inhalers suitable for administering these aerosols. In addition, the present invention relates to inhalers which are characterised in that they contain the propellant gas-containing aerosols described above according to the invention. The present invention also relates to cartridges which are fitted with a suitable valve and can be used in a suitable inhaler and which contain one of the above-mentioned propellant gas-containing inhalation aerosols according to the invention. Suitable cartridges and methods of filling these cartridges with the inhalable aerosols containing propellant gas according to the invention are known from the prior art .

C) Propellant- free inhalable solutions or suspensions containing the combinations of active substances 1 and 2 according to the invention: It is particularly preferred to use the active substance combination according to the invention in the form of propellant- free inhalable solutions and suspensions. The solvent used may be an aqueous or alcoholic, preferably an ethanolic solution. The solvent may be water on its own or a mixture of water and ethanol. The relative proportion of ethanol compared with water is not limited but the maximum is up to 70 percent by volume, more particularly up to 60 percent by volume and most preferably up to 30 percent by volume. The remainder of the volume is made up of water. The solutions or suspensions containing 1 and 2, separately or together, are adjusted to a pH of 2 to 7, preferably 2 to 5, using suitable acids. The pH may be adjusted using acids selected from inorganic or organic acids . Examples of suitable inorganic acids include hydrochloric acid, hydrobromic acid, nitric acid, sulphuric acid and/or phosphoric acid. Examples of particularly suitable organic acids include ascorbic acid, citric acid, malic acid, tartaric acid, maleic acid, succinic acid, fumaric acid, acetic acid, formic acid and/or propionic acid etc. Preferred inorganic acids are hydrochloric and sulphuric acids. It is also possible to use the acids which have already formed an acid addition salt with one of the active substances. Of the organic acids, ascorbic acid, fumaric acid and citric acid are preferred. If desired, mixtures of the above acids may be used, particularly in the case of acids which have other properties in addition to their acidifying qualities, e.g. as flavourings, antioxidants or complexing agents, such as citric acid or ascorbic acid, for example. According to the invention, it is particularly preferred to use hydrochloric acid to adjust the pH.

According to the invention, the addition of editic acid (EDTA) or one of the known salts thereof, sodium editate, as stabiliser or complexing agent is unnecessary in the present formulation. Other embodiments may contain this compound or these compounds. In a preferred embodiment the content based on sodium editate is less than lOOmg/lOOml, preferably less than 50mg/l00 ml, more preferably less than 20mg/100 ml. Generally, inhalable solutions in which the content of sodium editate is from 0 to lOmg/lOOml are preferred.

Co- solvents and/or other excipients may be added to the propellant-free inhalable solutions according to the invention. Preferred co-solvents are those which contain hydroxyl groups or other polar groups, e.g. alcohols -particularly isopropyl alcohol, glycols - particularly propyleneglycol, polyethyleneglycol, polypropyleneglycol , glycolether, glycerol, polyoxyethylene alcohols and polyoxyethylene fatty acid esters. The terms excipients and additives in this context denote any pharmacologically acceptable substance which is not an active substance but which can be formulated with the active substance or substances in the pharmacologically suitable solvent in order to improve the qualitative properties of the active substance formulation.

Preferably, these substances have no pharmacological effect or, in connection with the desired therapy, no appreciable or at least no undesirable pharmacological effect. The excipients and additives include, for example, surfactants such as soya lecithin, oleic acid, sorbitan esters, such as polysorbates , polyvinylpyrrolidone, other stabilisers, complexing agents, antioxidants and/or preservatives which guarantee or prolong the shelf life of the finished pharmaceutical formulation, flavourings, vitamins and/or other additives known in the art. The additives also include pharmacologically acceptable salts such as sodium chloride as isotonic agents.

The preferred excipients include antioxidants such as ascorbic acid, for example, provided that it has not already been used to adjust the pH, vitamin A, vitamin E, tocopherols and similar vitamins and provitamins occurring in the human body.

Preservatives may be used to protect the formulation from contamination with pathogens. Suitable preservatives are those which are known in the art, particularly cetyl pyridinium chloride, benzalkonium chloride or benzoic acid or benzoates such as sodium benzoate in the concentration known from the prior art. The preservatives mentioned above are preferably present in concentrations of up to 50mg/100ml, more preferably between 5 and 20mg/100ml.

Preferred formulations contain, in addition to the solvent water and the combination of active substances 1 and 2, only benzalkonium chloride and sodium editate. In another preferred embodiment, no sodium editate is present .

The propellant-free inhalable solutions according to the invention are administered in particular using inhalers of the kind which are capable of nebulising a small amount of a liquid formulation in the therapeutic dose within a few seconds to produce an aerosol suitable for therapeutic inhalation. Within the scope of the present invention, preferred inhalers are those in which a quantity of less than ΙΟΟμΐι, preferably less than 50μΐ,, more preferably between 20 and 30μΙ_ι of active substance solution can be nebulised in preferably one spray action to form an aerosol with an average particle size of less than 20μπι, preferably less than ΙΟμαι, in such a way that the inhalable part of the aerosol corresponds to the therapeutically effective quantity.

An apparatus of this kind for propellant-free delivery of a metered quantity of a liquid pharmaceutical composition for inhalation is described for example in International Patent Application WO 91/14468 and also in WO 97/12687 (cf . in particular Figures 6a and 6b) . The nebulisers (devices) described therein are known by the name Respimat® .

This nebuliser (Respimat®) can advantageously be used to produce the inhalable aerosols according to the invention containing the combination of active substances 1 and 2. Because of its cylindrical shape and handy size of less than 9 to 15 cm long and 2 to 4 cm wide, this device can be carried at all times by the patient. The nebuliser sprays a defined volume of pharmaceutical formulation using high pressures through small nozzles so as to produce inhalable aerosols.

The preferred atomiser essentially consists of an upper housing part, a pump housing, a nozzle, a locking mechanism, a spring housing, a spring and a storage container, characterised by a pump housing which is secured in the upper housing part and which comprises at one end a nozzle body with the nozzle or nozzle arrangement, a hollow plunger with valve body, a power takeoff flange in which the hollow plunger is secured and which is located in the upper housing part, a locking mechanism situated in the upper housing part , a spring housing with the spring contained therein, which is rotatably mounted on the upper housing part by means of a rotary bearing, - a lower housing part which is fitted onto the spring housing in the axial direction.

The hollow plunger with valve body corresponds to a device disclosed in WO 97/12687. It projects partially into the cylinder of the pump housing and is axially movable within the cylinder. Reference is made in particular to Figures 1 to 4, especially Figure 3, and the relevant parts of the description. The hollow plunger with valve body exerts a pressure of 5 to 60 Mpa (about 50 to 600 bar) , preferably 10 to 60 pa (about 100 to 600 bar) on the fluid, the measured amount of active substance solution, at its high pressure end at the moment when the spring is actuated. Volumes of 10 to 50 microlitres are preferred, while volumes of 10 to 20 microlitres are particularly preferred and a volume of 15 microlitres per spray is most particularly preferred.

The valve body is preferably mounted at the end of the hollow plunger facing the valve body.

The nozzle in the nozzle body is preferably microstructured, i.e. produced by microtechnology .

Microstructured valve bodies are disclosed for example in WO-94/07607; reference is hereby made to the contents of this specification, particularly Figure 1 therein and the associated description.

The valve body consists for example of two sheets of glass and/or silicon firmly joined together, at least one of which has one or more microstructured channels which connect the nozzle inlet end to the nozzle outlet end. At the nozzle outlet end there is at least one round or non-round opening 2 to 10 microns deep and 5 to 15 microns wide, the depth preferably being 4.5 to 6.5 microns while the length is preferably 7 to 9 microns .

In the case of a plurality of nozzle openings, preferably two, the directions of spraying of the nozzles in the nozzle body may extend parallel to one another or may be inclined relative to one another in the direction of the nozzle opening. In a nozzle body with at least two nozzle openings at the outlet end the directions of spraying may be at an angle of 20 to 160° to one another, preferably 60 to 150°, most preferably 80 to 100°. The nozzle openings are preferably arranged at a spacing of to 200 microns, more preferably at a spacing of 10 to 100 microns, most preferably 30 to 70 microns. Spacings of 50 microns are most preferred. The directions of spraying will therefore meet in the vicinity of the nozzle openings.

The liquid pharmaceutical preparation strikes the nozzle body with an entry pressure of up to 600 bar, preferably 200 to 300 bar, and is atomised into an inhalable aerosol through the nozzle openings. The preferred particle or droplet sizes of the aerosol are up to 20 microns, preferably 3 to 10 microns.

The locking mechanism contains a spring, preferably a cylindrical helical compression spring, as a store for the mechanical energy. The spring acts on the power takeoff flange as an actuating member the movement of which is determined by the position of a locking member. The travel of the power takeoff flange is precisely limited by an upper and lower stop. The spring is preferably biased, via a power step-up gear, e.g. a helical thrust gear, by an external torque which is produced when the upper housing part is rotated counter to the spring housing in the lower housing part. In this case, the upper housing part and the power takeoff flange have a single or multiple V-shaped gear.

The locking member with engaging locking surfaces is arranged in a ring around the power takeoff flange. It consists, for example, of a ring of plastic or metal which is inherently radially elastically deformable. The ring is arranged in a plane at right angles to the atomiser axis. After the biasing of the spring, the locking surfaces of the locking member move into the path of the power takeoff flange and prevent the spring from relaxing. The locking member is actuated by means of a button. The actuating button is connected or coupled to the locking member. In order to actuate the locking mechanism, the actuating button is moved parallel to the annular plane, preferably into the atomiser,- this causes the deformable ring to deform in the annual plane.

Details of the construction of the locking mechanism are given in WO 97/20590.

The lower housing part is pushed axially over the spring housing and covers the mounting, the drive of the spindle and the storage container for the fluid.

When the atomiser is actuated the upper housing part is rotated relative to the lower housing part, the lower housing part taking the spring housing with it. The spring is thereby compressed and biased by means of the helical thrust gear and the locking mechanism engages automatically. The angle of rotation is preferably a whole-number fraction of 360 degrees, e.g. 180 degrees. At the same time as the spring is biased, the power takeoff part in the upper housing part is moved along by a given distance, the hollow plunger is withdrawn inside the cylinder in the pump housing, as a result of which some of the fluid is sucked out of the storage container and into the high pressure chamber in front of the nozzle .

If desired, a number of exchangeable storage containers which contain the fluid to be atomised may be pushed into the atomiser one after another and used in succession.

The storage container contains the aqueous aerosol preparation according to the invention.

The atomising process is initiated by pressing gently on the actuating button. As a result, the locking mechanism ' opens up the path for the power takeoff member. The biased spring pushes the plunger into the cylinder of the pump housing. The fluid leaves the nozzle of the atomiser in atomised form.

Further details of construction are disclosed in PCT Applications WO 97/12683 and WO 97/20590, to which reference is hereby made.

The components of the atomiser (nebuliser) are made of a material which is suitable for its purpose. The housing of the atomiser and - if its operation permits, other parts as well are preferably made of plastics, e.g. by injection moulding. For medicinal purposes, physiologically safe materials are used.

Figures 2a/b attached to this patent application, which are identical to Figures 6a/b of WO 97/12687, show the nebuliser (Respimat®) which can advantageously be used for inhaling the aqueous aerosol preparations according to the invention.

Figure 2a shows a longitudinal section through the atomiser with the spring biased while Figure 2b shows a longitudinal section through the atomiser with the spring relaxed .

The upper housing part (51) contains the pump housing (52) on the end of which is mounted the holder (53) for the atomiser nozzle. In the holder is the nozzle body (54) and a filter (55) . The hollow plunger (57) fixed in the power takeoff flange (56) of the locking mechanism projects partially into the cylinder of the pump housing. At its end the hollow plunger carries the valve body (58) . The hollow plunger is sealed off by means of the seal (59) . Inside the upper housing part is the stop (60) on which the power takeoff flange abuts when the spring is relaxed. On the power takeoff flange is the stop (61) on which the power takeoff flange abuts when the spring is biased. After the biasing of the spring the locking member (62) moves between the stop (61) and a support (63) in the upper housing part. The actuating button (64) is connected to the locking member. The upper housing part ends in the mouthpiece (65) and is sealed off by means of the protective cover (66) which can be placed thereon.

The spring housing (67) with compression spring (68) is rotatably mounted on the upper housing part by means of the snap- in lugs (69) and rotary bearing. The lower housing part (70) is pushed over the spring housing.

Inside the spring housing is the exchangeable storage container (71) for the fluid (72) which is to be atomised. The storage container is sealed off by the stopper (73) through which the hollow plunger projects into the storage container and is immersed at its end in the fluid (supply of active substance solution) .

The spindle (74) for the mechanical counter is mounted in the covering of the spring housing. At the end of the spindle facing the upper housing part is the drive pinion (75) . The slider (76) sits on the spindle.

The nebuliser described above is suitable for nebulising the aerosol preparations according to the invention to produce an aerosol suitable for inhalation.

If the formulation according to the invention is nebulised using the method described above (Respimat®) the quantity delivered should correspond to a defined quantity with a tolerance of not more than 25%, preferably 20% of this amount in at least 97%, preferably at least 98% of all operations of the inhaler (spray actuations) . Preferably, between 5 and 30 mg of formulation, most preferably between 5 and 20 mg of formulation are delivered as a defined mass on each actuatio .

However, the formulation according to the invention may also be nebulised by means of inhalers other than those described above, e.g. jet stream inhalers or other stationary nebulisers.

Accordingly, in a further aspect, the invention relates to pharmaceutical formulations in the form of propellant-f ee inhalable solutions or suspensions as described above combined with a device suitable for administering these formulations, preferably in conjunction with the Respimat®. Preferably, the invention relates to propellant-free inhalable solutions or suspensions characterised by the combination of active substances 1 and 2 according to the invention in conjunction with the device known by the name Respimat®. In addition, the present invention relates to the above-mentioned devices for inhalation, preferably the Respimat®, characterised in that they contain the propellant-free inhalable solutions or suspensions according to the invention as described hereinbefore.

The propellant-free inhalable solutions or suspensions according to the invention may take the form of concentrates or sterile inhalable solutions or suspensions ready for use, as well as the above-mentioned solutions and suspensions designed for use in a Respimat®. Formulations ready for use may be produced from the concentrates, for example, by the addition of isotonic saline solutions. Sterile formulations ready for use may be administered using energy-operated fixed or portable nebulisers which produce inhalable aerosols by means of ultrasound or compressed air by the Venturi principle or other principles.

Accordingly, in another aspect, the present invention relates to pharmaceutical compositions in the form of propellant-free inhalable solutions or suspensions as described hereinbefore which take the form of concentrates or sterile formulations ready for use, combined with a device suitable for administering these solutions, characterised in that the device is an energy-operated free-standing or portable nebuliser which produces inhalable aerosols by means of ultrasound or compressed air by the Venturi principle or other methods.

The Examples which follow serve to illustrate the present invention in more detail without restricting the scope of the invention to the following embodiments by way of example.

Starting materials Tiotropium bromide: The tiotropium bromide used in the following formulations examples may be obtained as described in European Patent Application 418 716 Al .

In order to prepare the inhalable powders according to the invention, crystalline tiotropium bromide monohydrate may also be used. This crystalline tiotropium bromide monohydrate may be obtained by the method described below . .0 kg of tiotropium bromide are placed in 25.7 kg of water in a suitable reaction vessel. The mixture is heated to 80-90°C and stirred at constant temperature until a clear solution is formed. Activated charcoal (0.8 kg) moistened with water is suspended in 4.4 kg of water, this mixture is added to the solution containing the tiotropium bromide and the resulting mixture is rinsed with 4.3 kg of water. The mixture thus obtained is stirred for at least 15 minutes at 80-90°C and then filtered through a heated filter into an apparatus preheated to an external temperature of 70°C. The filter is rinsed with 8.6 kg of water. The contents of the apparatus are cooled at 3-5°C for every 20 minutes to a temperature of 20-25°C. The apparatus is cooled further to 10-15°C using cold water and crystallisation is completed by stirring for at least another hour. The crystals are isolated using a suction filter dryer, the crystal slurry isolated is washed with 9 litres of cold water (10-15°C) and cold acetone (10-15°C) . The crystals obtained are dried at 25°C in a nitrogen current over a period of 2 hours .

Yield: 13.4 kg of tiotropium bromide monohydrate (86% of theory) .

The crystalline tiotropium bromide monohydrate thus obtained is micronised by known methods in order to prepare the active substance in the form of the average particle size corresponding to the specifications according to the invention.

Examples of Formulations A) Inhalable powders : 1) Ingredients g per capsule Tiotropium bromide 21.7 AWD-12-281 200 Lactose 4778.3 Total 5000 Ingredients g per capsule Tiotropium bromide 21.7 AWD-12-281 125 Lactose 4853.3 Total 5000 3) Ingredients g per capsule Tiotropium bromide x H-0 22.5 AWD-12-281 250 Lactose 4727.5 Total 5000 4) Ingredients μg per capsule Tiotropium bromide 21.7 AWD-12-281 250 Lactose 4728.3 Total 5000 ) 6) 7) B) Propellant eras -containing aerosols for inhalation: 1) Suspension aerosol: Ingredients wt . -% Tiotropium bromide 0.015 AWD-12-281 0.066 Soya lecithin 0.2 TG 134a: TG227 = 2:3 ad 100 ) Suspension aerosol: ) Suspension aerosol: ) Suspension aerosol Ingredients wt . -% Tiotropium bromide 0.029 AWD-12-281 0.033 absolute ethanol 0.5 isopropyl myristate 0.1 TG 227 ad 100 157326/2 Suspension aerosol *** **************************** ******** Passages of the description, which are not within the scope of the claims, do not consist part of the claimed invention.

Claims (31)

- 36 - 157326/2 CLAIMS :

1. Pharmaceutical composition characterized in that it contains one or more tiotropium salts (1) combined with one or more PDE-IV inhibitors (2), optionally in the form of the enantiomers, mixtures of the enantiomers or in the form of the racemates thereof, optionally in the form of the solvates or hydrates and optionally together with a pharmaceutically acceptable excipient.

2. Pharmaceutical composition according to claim 1, characterized in that the active substances 1 and 2 are present either together in a single formulation or in two separate formulations.

3. Pharmaceutical composition according to one of claims 1 to 2, characterized in that 1 is present in the form of the chloride, bromide, iodide, methanesulphonate, paratoluene sulphonate or methyl sulphate, preferably in the form of the bromide.

4. Pharmaceutical composition according to one of claims 1 to 3, characterized in that 2 is selected from among enprofylline, roflumilast, ariflo, Bay-198004, CP-325, 366, BY343, D-4396 (Sch-351591 ) , V-11294A, AWD-12-281 and the tricyclic nitrogen heterocycles of general formula 2a wherein R1 denotes Ci-C5-alkyl, C5-C6-cycloalkyl, phenyl, benzyl or a 5- or 6-membered, saturated or unsaturated heterocyclic ring which may contain - 37 - 157326/2 one or two heteroatoms selected from among oxygen and nitrogen; R2 denotes Ci-C5-alkyl or C2-C4-alkenyl; R3 denotes Ci-C5-alkyl which may optionally be substituted by Ci-Cj-alkoxy, C5-C6-cycloalkyl, phenoxy or a 5- or 6-membered, saturated or unsaturated heterocyclic ring which may contain one or two heteroatoms selected from among oxygen and nitrogen; C5-C6-cycloalkyl or phenyl or benzyl optionally substituted by Ci-C-alkoxy, optionally in the form of their racemates, their enantiomers, in the form of the diastereomers and the mixtures thereof, optionally in the form of their tautomers and optionally the pharmacologically acceptable acid addition salts thereof.

5. Pharmaceutical composition according to one of claims 1 to 4, characterized in that 2 is selected from among enprofylline, roflumilast, ariflo, AWD-12-281 and the tricyclic nitrogen heterocycles of general formula 2a.

6. Pharmaceutical compositions according to one of claims 1 to 5, characterized in that the weight ratios of 1 to 2 are in the range from 1:300 to 50:1, preferably from 1:250 to 40:1.

7. Pharmaceutical composition according to one of claims 1 to 6, characterized in that a single dose adapted for administration corresponds to a dose of the active substance combination 1 and 2 of 0.01 to lOOOC^g, preferably from 0.1 to 2000μg.

8. Pharmaceutical composition according to one of claims 1 to 7, characterized in that it is in the form of a formulation suitable for inhalation.

9. Pharmaceutical composition according to claim 8, characterized in that it is a formulation selected from among inhalable powders, propellant-containing metering - 38 - 157326/2 aerosols and propellant-free inhalable solutions or suspensions .

10. Pharmaceutical composition according to claim 9, characterized in that it is an inhalable powder which contains 1 and 2 in admixture with suitable physiologically acceptable recipients selected from among the monosaccharides, disaccharides, oligo- and polysaccharides, polyalcohols , salts or mixtures of these excipients with one another.

11. Inhalable powder according to claim 10, characterized in that the excipient has a maximum average particle size of up to 250um, preferably between 10 and 150μπι.

12. Capsules, characterized in- that they contain an inhalable powder according to claim 10 or 11.

13. Pharmaceutical composition according to claim 9, characterized in that it is an inhalable powder which contains only the active substances 1 and 2 as its ingredients .

14. Pharmaceutical composition according to claim 9, characterized in that it is a propellant-containing inhalable aerosol which contains 1 and 2 in dissolved or dispersed form.

15. Propellant-containing inhalable aerosol according to claim 14, characterized in that it contains, as propellant gas, hydrocarbons such as' n-propane, n-butane or isobutene or halohydrocarbons such as chlorinated and/or fluorinated derivatives of methane, ethane, propane, butane, cyclopropane or cyclobutane.

16. Propellant-containing inhalable aerosol according to claim 15, characterized in that the propellant gas is TG134a, TG227 or a mixture thereof.

17. Propellant-containing inhalable aerosol according to claim 14, 15 or 16, characterized in that it optionally - 39 - 157326/2 contains one or more other ingredients selected from among ■co-solvents, stabilizers, surfactants, antioxidants, lubricants and means for adjusting the pH.

18. Propellant-containing inhalable aerosol according to one of claims 14 to 17, characterized in that it may contain up to 5 wt.-% of active substance 1 and/or 2.

19. Pharmaceutical composition according to claim 9, characterized in that it is a propellant-free inhalable solution or suspension which contains water, ethanol or a mixture of water and ethanol as solvent.

20. Inhalable solution or suspension according to claim 19, characterized in that the pH is 2 - 7, preferably 2 - 5.

21. Inhalable solution or suspension according to claim 20, characterized in that the pH is adjusted by means of an acid selected from among hydrochloric acid, hydrobromic acid, nitric acid, sulphuric acid, ascorbic acid, citric acid, malic acid, tartaric acid, maleic acid, succinic acid, fumaric acid, acetic acid, formic acid and propionic acid or mixtures thereof.

22. Inhalable solutions or suspension according to one of claims 19 to 21, characterized in that it optionally contains other co-solvents and/or excipients.

23. Inhalable solution or suspension according to claim 22, characterized in that it contains as co-solvents ingredients which contain hydroxyl groups or other polar groups, e.g. alcohols - particularly isopropyl alcohol, glycolis - particularly propyleneglycol, polyethyleneglycol , polypropyleneglycol, glycolether, glycerol, polyoxyethylene alcohols and polyoxyethylene fatty acid esters.

24. Inhalable solution or suspension according to one of claims 22 or 23, characterized in that it contains as excipients surfactants, stabilizers, complexing agents, - 40 - 157326/2 antioxidants and/or preservatives, flavourings, pharmacologically acceptable salts and/or vitamins.

25. Inhalable solution or suspension according to claim 24, characterized in that it contains as complexing agent editic acid or a salt or editic acid, preferably sodium edetate .

26. Inhalable solution or suspension according to claim 24 or 25, characterized in that it contains, as antioxidants, compounds selected from among ascorbic acid, vitamin A, vitamin E and tocopherols.

27. Inhalable solution or suspension according to claim 24, 25 or 26, characterized in that it contains as preservatives compounds selected from cetyl pyridinium chloride, benzalkonium chloride, benzoic acid and benzoates.

28. Inhalable solution or suspension according to one of claims 22 to 27, characterized in that it contains, in addition to the active substances 1 and 2 and the solvent, only benzalkonium chloride and sodium edetate.

29. Inhalable solution or suspension according to one of claims 22 to 27, characterized in that it contains, in addition to the active substances 1 and 2 and the solvent, only benzalkonium chloride.

30. Inhalable solution or suspension according to one of claims 19 to .29, characterized in that it is a concentrate or a sterile ready-to-use inhalable solution or suspension.

31. Use of a composition according to one of claims 1 to 30 for preparing a medicament for treating inflammatory or obstructive diseases of the respiratory tract . For the Applicants,