Letters Tiotropium mist inhaler

Another plausible explanation for mist inhaler’s toxicity

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4483 (Published 25 July 2011) Cite this as: BMJ 2011;343:d4483
  1. Martin J Seed, consultant occupational physician1,
  2. Paul Cullinan, professor in occupational and environmental respiratory disease2,
  3. Raymond Agius, professor of occupational and environmental medicine1
  1. 1Centre for Occupational and Environmental Health, University of Manchester, Manchester M13 9PL, UK
  2. 2National Heart and Lung Institute at Imperial College, London, UK
  1. martin.seed{at}manchester.ac.uk

In seeking an explanation for the apparent increase in all cause mortality associated with tiotropium delivered by the Respimat Soft Mist Inhaler compared with the Handihaler, Singh and colleagues focus on the possibility of increased cardiovascular deaths as a result of the higher peak plasma concentrations of tiotropium …

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