Tiotropium in Combination with Placebo, Salmeterol, or Fluticasone–Salmeterol for Chronic Obstructive Pulmonary Disease: Possible Confounding Effect of Treatment Withdrawal?

TO THE EDITOR:

Aaron and colleagues (1) present a study designed to answer a clinically relevant question of whether 2 expensive therapies are better than 1 when the individual components seem to be separately efficacious. Unfortunately, the authors failed to consider the extent to which clinical practice had already outstripped the evidence. They report that as …