Tiotropium Respimat Inhaler and the Risk of Death in COPD

• Published in: The New England journal of medicine Vol. 369; no. 16; pp. 1491 - 1501
• Main Authors: Wise, Robert A, Anzueto, Antonio, Cotton, Daniel, Dahl, Ronald, Devins, Theresa, Disse, Bernd, Dusser, Daniel, Joseph, Elizabeth, Kattenbeck, Sabine, Koenen-Bergmann, Michael, Pledger, Gordon, Calverley, Peter
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 17.10.2013
• Subjects: Administration, Inhalation; Aged; Aged, 80 and over; Aqueous solutions; Biological and medical sciences; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - adverse effects; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Clinical trials; Confidence intervals; Coronary artery disease; Death; Double-Blind Method; Drug therapy; Female; Forced Expiratory Volume; General aspects; Heart diseases; Humans; Inhalation; Inhalers; Kaplan-Meier Estimate; Lung diseases; Male; Medical sciences; Middle Aged; Mortality; Nebulizers and Vaporizers; Obstructive lung disease; Patients; Pneumology; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - mortality; Risk; Safety; Scopolamine Derivatives - administration & dosage; Scopolamine Derivatives - adverse effects; Spirometry; Tiotropium Bromide; Delivery system; Lung disease; Prognosis; Respiratory disease; Tiotropium bromide; Bronchodilator; Mortality; Medicine; Anticholinergic agent; Risk factor; Inhaler; Bronchus disease; Chronic obstructive pulmonary disease
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1303342

This large trial involving patients with chronic obstructive pulmonary disease examined the relative safety of tiotropium inhalation delivered by two different devices. No significant differences in mortality were noted between the two devices. Tiotropium (Spiriva, Boehringer Ingelheim), a long-acting inhaled anticholinergic bronchodilator, improves lung function, quality of life, and exercise endurance and reduces exacerbations in patients with chronic obstructive pulmonary disease (COPD). 1 – 4 Tiotropium is approved and marketed as a dry-powder formulation delivered by means of the HandiHaler inhalation device (at a dose of 18 μg) 5 and as an aqueous solution delivered by means of the Respimat inhaler (at a dose of 5 μg) in many countries. 6 Crossover trials of tiotropium Respimat at a dose of 5 μg and HandiHaler at a dose of 18 μg for up to 4 weeks have shown . . .