Response

摘要

Mathioudakis A et al. discussed an increased risk of mortality in Respimat compared to HandiHaler. Our recent article by Asakura Y et al. showed only the short-term usefulness and safety of Respimat in a small population study. Certainly, long-term safety, especially the difference in mortality between devices, is an important problem to be solved. Singh S et al. first showed the possibility of an increased risk of mortality in Respimat compared to HandiHaler by meta-analysis. However, this meta-analysis is constructed from limited data from published articles. It is not the final opinion that Respimat increases mortality compared to HandiHaler in the patients with COPD. The difference of mortality between tiotropium devices should be explained by a large multicenter study, which is ongoing now. Of course, discussion about the differences in mortality between HandiHaler and Respimat is welcome. However, I think the opinion about an increased mortality in Respimat should be more carefully and not definitively discussed.