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Authors’ response to Walker et al.
  1. D P Tashkin1,
  2. N Metzdorf2,
  3. C Hallmann2,
  4. I Leimer2,
  5. T Lee3,
  6. M Decramer4
  1. 1David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
  2. 2Clinical Development & Medical Affairs Ingelheim, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
  3. 3Pfizer Inc., New York, New York, USA
  4. 4Respiratory Division, KU Leuven, Leuven, Belgium
  1. Correspondence to Dr Norbert Metzdorf, TA Respiratory Diseases, Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Strasse 173, D-55216 Ingelheim am Rhein, Germany; norbert.metzdorf{at}

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The research letter by Walker et al1 questions the generalisability of the results of the 4-year UPLIFT trial comparing tiotropium versus placebo based on potential eligibility for UPLIFT at time of discharge of a COPD patient population in New Zealand hospitalised for an exacerbation. The authors state that 38% of their study population would have been excluded from UPLIFT. The authors' assertion regarding the limited generalisability of UPLIFT's findings to clinical practice is not valid for several reasons.

First, patients hospitalised for COPD exacerbations are not representative of the general COPD population. An epidemiological analysis from The Netherlands2 reported that 2.1% and 4.4% of COPD patients (mean age, 68 years) starting treatment with HandiHaler and Respimat, respectively, had a COPD-related hospitalisation in the year preceding the analysis. Analysis of an elderly Canadian COPD population3 showed that 9.8% were recently hospitalised for acute respiratory conditions. These epidemiological data suggest that the COPD population studied by Walker et al is not representative of the general COPD population. …

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