Guidance for clinicians on how to interpret conflicting evidence from recent studies
Patients with advanced chronic obstructive pulmonary disease (COPD) have profound functional impairment and increased mortality.1 Inhaled bronchodilators, including the anticholinergic agents tiotropium bromide and ipratropium bromide, relieve symptoms and improve lung function and quality of life. Tiotropium also reduces COPD exacerbations and hospitalisations.2
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- 1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2008). http://www.goldcopd.org (accessed Dec 2008).
- 2. Barr RG, Bourbeau J, Camargo CA, Ram FS. Tiotropium for stable chronic obstructive pulmonary disease: a meta-analysis. Thorax 2006; 61: 854-862.
- 3. US Food and Drug Administration. Early communication about an ongoing safety review of tiotropium (marketed as Spiriva HandiHaler). http://www.fda.gov/cder/drug/early_comm/tiotropium.htm (accessed Dec 2008).
- 4. Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA 2008; 300: 1439-1450. Erratum in: JAMA 2009; 301: 1227-1230.
- 5. Lee TA, Pickard AS, Au DH, et al. Risk for death associated with medications for recently diagnosed chronic obstructive pulmonary disease. Ann Intern Med 2008; 149: 380-390.
- 6. Maclay JD, McAllister DA, Macnee W. Cardiovascular risk in chronic obstructive pulmonary disease. Respirology 2007; 12: 634-641.
- 7. Wedzicha JA, Calverley PM, Seemungal TA, et al; INSPIRE Investigators. The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med 2008; 177: 19-26.
- 8. Tashkin DP, Celli B, Senn S, et al; UPLIFT Study Investigators. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med 2008; 359: 1543-1554.
- 9. de Luise C, Lanes SF, Jacobsen J, et al. Cardiovascular and respiratory hospitalizations and mortality among users of tiotropium in Denmark. Eur J Epidemiol 2007; 22: 267-272.
- 10. Suissa S, Hemmelgarn B, Blais L, Ernst P. Bronchodilators and acute cardiac death. Am J Respir Crit Care Med 1996; 154: 1598-1602.
Mark Hew received travel assistance from AstraZeneca and Altana to attend three conferences in 2004–2005. Louis Irving has in the past received support from GlaxoSmithKline, AstraZeneca and Boehringer Ingelheim to attend American and European Respiratory Society meetings and industry-supported educational meetings in Australia.