Outcomes Are Similar with Fine-Mist and Dry-Powder Tiotropium Inhalers

Tiotropium (Spiriva) is available (in the U.S.) in the 14-µg dry-powder Handihaler device and (in other countries) in the 5-µg fine-mist, propellant-free Respimat device. Meta-analyses of Respimat trial data in patients with chronic obstructive pulmonary disease (COPD) showed excess all-cause mortality with Respimat, especially among patients with cardiovascular disease. Conversely, in the UPLIFT trial, mortality was lower with Handihaler than with placebo (NEJM JW Gen Med Oct 27 2009). Concerns about the excess mortality in Respimat studies led to calls for a worldwide ban on the Respimat formulation.

To analyze the differences between Respimat and Handihaler further, researchers randomized 17,000 patients with COPD to tiotropium delivered …