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Systematic Review and meta-analysis
Tiotropium mist inhaler for COPD increases risk of mortality compared with placebo
  1. Felix S F Ram
  1. School of Health and Social Sciences, Massey University, Auckland, New Zealand
  1. Correspondence to: Felix S F Ram
    School of Health and Social Sciences, Massey University, Private Bag 102–904, North Shore, Auckland 0630, New Zealand; fsfram{at}

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Spiriva or tiotropium bromide (long-acting muscarinic receptor antagonist) is licensed for maintenance bronchodilator treatment in the management of chronic obstructive pulmonary disease (COPD) in 55 countries. Singh and colleagues conducted a systematic review of high-quality randomised controlled trials (RCTs) and assessed all-cause mortality in COPD patients using the Spiriva Respimat Soft Mist Inhaler (RSMI) compared with placebo.


The authors conducted a systematic review of high-quality RCTs with 6522 patients. All included trials were of parallel design with study duration varying from 12 to 52 weeks. The authors conducted various sensitivity analyses to test the robustness of their findings which included using random effects …

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  • Competing interests None.