Tiotropium, a long-acting inhaled anticholingeric bronchodilator, is commonly used to prevent COPD exacerbations (1). Tiotropium is available as a dry powder (HandiHaler) or aqueous solution (Respimat). Direct comparisons of the two formulations are lacking. Prior post-hoc analyses suggest that that Respimat may be more efficacious than HandiHaler (2) but it may also increase the risk of death, particularly among those with cardiac dysrhythmias (3-6).
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