NEW YORK (Reuters Health) – In patients with recently diagnosed chronic obstructive pulmonary disease (COPD), the use of ipratropium may increase all-cause and cardiovascular mortality, US researchers report. Inhaled corticosteroids, by contrast, may have just the opposite effect.

Data from randomized trials have raised concerns about the safety of COPD medications, Dr. Todd A. Lee, from Hines Veterans Affairs Hospital in Illinois, and colleagues note. The degree to which this applies to real world settings, however, is unclear.

The current investigation, reported in the Annals of Internal Medicine for September 16, included US veterans who had used the healthcare system provided by the Veterans Administration from October 1999 through September 2004. The case-control study, used for the main mortality analysis, included 32,130 COPD patients who died during follow-up and 320,501 who did not.

Dr. Lee’s group found that treatment with the anticholinergic bronchodilator ipratropium in the preceding 6 months increased all-cause mortality by 11%, whereas inhaled corticosteroid use cut mortality by 20%. There was also a tendency toward increased mortality with theophylline and decreased mortality with long-acting beta-agonists.

Similar effects were noted when examining the impact on cardiovascular death. Ipratropium use was linked to a 34% increased risk of cardiovascular death, while inhaled corticosteroids appeared to reduce the risk by 20%.

“Our study contributes important new evidence on the potential harms associated with medications used in COPD,” the investigators conclude.

Although ipratropium seemed to increase the risk of death, the authors note, this effect may be reduced or eliminated all together when inhaled corticosteroids are used at the same time.

Moreover, they emphasize that the risks associated with ipratropium and other COPD agents “must be weighed against potential benefits of these medications that are not captured in observational database studies, such as symptom relief, health status, or quality of life.”

Reference:
Ann Intern Med 2008;149:380-390.