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The editorial by Jenkins and Beasley1 makes a speculative recommendation that tiotropium Respimat should not be prescribed in the treatment of chronic obstructive pulmonary disease (COPD), being primarily based on meta-analysis where mortality was not the primary end point. The meta-analysis by Singh et al 2 reported that treating 124 patients per annum with tiotropium Respimat 5 ug resulted in one additional death, although the associated 95% CI of 52 to 5682 clearly indicates that the data are not particularly robust. In considering the risk-benefit ratio of tiotropium one has to consider the seed and the soil, in terms of the degree of systemic exposure and the predisposing cardiovascular status. There is …
Footnotes
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Competing interests BJL has received placebo inhalers as an unrestricted educational gift from Boehringer Ingelheim, payment from Boehringer to attend an Advisory Board and financial support from Boehringer to attend the Winter British Thoracic Society meeting 2012. PMS received financial support from Boehringer Ingelheim to attend the European Respiratory Society meeting in 2009.
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Provenance and peer review Not commissioned; internally peer reviewed.