Intended for healthcare professionals

Rapid response to:


Call for worldwide withdrawal of tiotropium Respimat mist inhaler

BMJ 2012; 345 doi: (Published 09 November 2012) Cite this as: BMJ 2012;345:e7390

Rapid Response:

Re: Call for worldwide withdrawal of tiotropium Respimat mist inhaler

Dr Miles raises the important historical perspective of the role of inhaled bronchodilator use and risk of mortality in asthma.1-3 Two epidemics of asthma mortality have occurred with the use of high dose preparations of potent, poorly selective beta-2 agonists, isoprenaline and fenoterol (Berotec). In each epidemic it was not until the regulatory authorities severely restricted the availability of the high dose preparations of isoprenaline and fenoterol that the asthma mortality rates fell dramatically and the epidemics resolved. It would be preferable on this occasion for Boehringer Ingelheim (the manufacturer of Respimat Mist Inhaler) and/or the regulatory authorities to take the required steps before, rather than after an epidemic of preventable COPD mortality occurs.


1. Crane J, Pearce N, Flatt A, Burgess C, Jackson R, Kwong T, Ball M, Beasley R. Prescribed fenoterol and death from asthma in New Zealand, 1981-83: A case control study. Lancet 1989; 1(8644): 917-22.
2. Pearce N, Beasley R, Crane J, Burgess C. Epidemiology of asthma mortality. In: Asthma and Rhinitis. 2nd Edition (Eds) Holgate ST, Busse WW. Blackwell Scientific Press, Oxford: 2000, 56-69.
3. Pearce N, Beasley R, Crane J, Burgess C, Jackson R. End of the New Zealand asthma mortality epidemic. Lancet 1995; 345: 41-44.

Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; RB received funding from Boehringer Ingelheim to present at a symposium; no other relationships or activities that could appear to have influenced the submitted work.

30 November 2012
Richard Beasley
Professor of Medicine
Sonal Singh, Yoon K Loke, Paul Enright, Curt D Furberg
Medical Research Institute of New Zealand
Private Bag 7902, Wellington 6242, NZ