Intended for healthcare professionals


Safety of tiotropium

BMJ 2011; 342 doi: (Published 14 June 2011) Cite this as: BMJ 2011;342:d2970
  1. Christopher J Cates, senior clinical research fellow
  1. 1St George’s University of London, London, SW17 0RE, UK
  1. chris{at}

Indirect evidence suggests the Respimat inhaler is riskier than the Handihaler

Tiotropium is used to treat chronic obstructive pulmonary disease via two different inhaler devices: the original Handihaler (18 µg once daily), which uses a powder formulation, and the newer Respimat mist inhaler (5 µg once daily). The two devices cannot be assumed to have the same safety profile, however, and the linked systematic review by Singh and colleagues (doi:10.1136/bmj.d3215) assessed all cause mortality in people with chronic obstructive pulmonary disease using the Respimat mist inhaler.1

An ongoing trial will provide more certainty about the comparative safety of tiotroprium inhaler devices


The authors assessed the risk of all doses of tiotropium given via the mist inhaler (including 10 µg daily), but because the usual dose in clinical practice is 5 µg daily, this editorial will focus on the safety results for this dose only. The review reported a 46% relative increase in risk of mortality from any cause in patients using the mist inhaler compared …

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