OBJECTIVE： To observe the clinical effect of tiotropium bromide combined with salmeterol xinafoate and fluticasone propionate in the treatment of  medium and severe COPD. METHODS： 119 patients with medium and severe COPD were divided into control group （54 cases） and observation group （65 cases） according to admission order. Control group was treated with Salmeterol xinafoate and fluticasone propionate powder for inhalation 50 μg， bid； observation group was additionally given Tiotropium bromide powder for inhalation 18 μg，qn. Both groups received 1 month of treatment. Lung function indexes as FEV1， FVC and IC， blood gas indexes as SaO2， PaCO2 and PaO2 and inflammatory factors as IL-8 and TNF-α， COPD assessment test （CAT） score were observed in 2 groups， and the occurrence of ADR was also observed. RESULTS： Before treatment， there was no statistical significance in above indexes between 2 groups （P＞0.05）. After treatment， FEV1， EVC， IC of observation group were increased significantly， SaO2 and PaO2 of observation group were increased significantly， while PaCO2， IL-8 and TNF-α levels was decreased significantly； those indexes of observation group were significantly better than  those of control group， with statistical significance （P＜0.05）.  CAT score of 2 groups were decreased significantly compared to before treatment， and the observation group was significantly lower than control group， with statistical significance （P＜0.05）. No obvious ADR was found in 2 groups. CONCLUSIONS：  Tiotropium bromide combined with salmeterol xinafoate and fluticasone propionate shows good clinical efficacy and safety in the treatment of medium and severe COPD.