TY - JOUR T1 - Tiotropium mist inhaler for COPD increases risk of mortality compared with placebo JF - Evidence Based Medicine JO - Evid Based Med SP - 189 LP - 190 DO - 10.1136/ebm.2011.100171 VL - 16 IS - 6 AU - Felix S F Ram Y1 - 2011/12/01 UR - http://ebm.bmj.com/content/16/6/189.abstract N2 - Commentary on: Singh S, Loke YK, Enright PL, et al. Mortality associated with tiotropium mist inhaler in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis of randomised controlled trials. BMJ 2011;342:d3215.OpenUrlAbstract/FREE Full Text 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 … ER -