Authors’ reply to ‘Explaining differential effects of tiotropium on mortality in COPD’
TL;DR: It is agreed that UPLIFT provides very reassuring data regarding the safety of tiotropium administered by the Handihaler device in a chronic obstructive pulmonary disease (COPD) population from which people with significant diseases other than COPD, which could compromise participation or put the patient at risk, were excluded.
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Abstract: We thank Dr Lipworth1 for his response to our editorial,2 which we emphasise related to the safety of tiotropium by Respimat, not by Handihaler. We agree that UPLIFT provides very reassuring data regarding the safety of tiotropium administered by the Handihaler device in a chronic obstructive pulmonary disease (COPD) population from which people with significant diseases other than COPD, which could compromise participation or put the patient at risk, were excluded. Patients with a range of commonly encountered comorbidities, including myocardial infarction in the recent 6 months, unstable arrhythmia or hospitalisation for heart failure in the recent 12 months, or need for oxygen therapy >12 h/day, and moderate renal impairment were not eligible for UPLIFT, thereby limiting the generalisability of the findings. We also …
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Advances in Device and Formulation Technologies for Pulmonary Drug Delivery
TL;DR: Recent device and formulation advances that are forming the current landscape of inhaled therapeutics, including integration of software and electronic assistance has become a shared trend.
References
Comparison of inhaled long-acting β-agonist and anticholinergic effectiveness in older patients with chronic obstructive pulmonary disease: a cohort study.
Andrea S. Gershon,Ruth Croxford,Teresa To,Matthew B. Stanbrook,Ross E.G. Upshur,Paula Sanchez-Romeu,Therese A. Stukel +6 more
TL;DR: Older adults initially prescribed long-acting inhaled β-agonists for the management of moderate COPD seem to have lower mortality than those initially prescribedLong-acting anticholinergics.
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Explaining differential effects of tiotropium on mortality in COPD
TL;DR: The editorial by Jenkins and Beasley1 makes a speculative recommendation that tiotropium Respimat should not be prescribed in the treatment of chronic obstructive pulmonary disease, being primarily based on meta-analysis where mortality was not the primary end point.
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Tiotropium Respimat increases the risk of mortality
TL;DR: Tiotropium is the mainstay long-acting bronchodilator for maintenance treatment in Chronic Obstructive Pulmonary Disease (COPD) and multiple randomised controlled trials have demonstrated its efficacy as an intervention which improves lung function, quality of life, symptom control and exercise capacity, and reduces exacerbations in patients with COPD.
Bronchodilators in Heart Failure Patients With COPD: Is It Time for a Clinical Trial?
TL;DR: This paper reviews bronchodilator therapy in HF and proposes a randomized trial designed to enroll patients with significant COPD and HF to determine the risks and/or benefits of adding a long-acting beta-2 agonist to patients currently taking along-acting anticholinergic agent.