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Bronchodilators in COPD: impact of beta-agonists and anticholinergics on severe exacerbations and mortality.

Salpeter SR - Int J Chron Obstruct Pulmon Dis (2007)

Bottom Line: In contrast, beta-agonist use had no effect on COPD hospitalizations and was associated with a two-fold increased risk for respiratory death compared with placebo.When the two bronchodilators were directly compared with each other, beta-agonists were associated with a two-fold increased risk for COPD hospitalization and a five-fold increased risk for total mortality compared with anticholinergics.When beta-agonists were added to either anticholinergic use or inhaled corticosteroid use alone, there was no significant improvement in any long-term clinical outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. salpeter@stanford.edu

ABSTRACT
This review summarizes the long-term clinical outcomes associated with beta-agonist and anticholinergic bronchodilator use in patients with chronic obstructive pulmonary disease (COPD). Pooled data from randomized placebo-controlled trials of at least three months duration were used to evaluate the risk for COPD hospitalizations, respiratory mortality, and total mortality. The results show that anticholinergic use is associated with a 30% reduction in COPD hospitalizations, a 70% reduction in respiratory mortality, and without a significant effect on total mortality. In contrast, beta-agonist use had no effect on COPD hospitalizations and was associated with a two-fold increased risk for respiratory death compared with placebo. When the two bronchodilators were directly compared with each other, beta-agonists were associated with a two-fold increased risk for COPD hospitalization and a five-fold increased risk for total mortality compared with anticholinergics. When beta-agonists were added to either anticholinergic use or inhaled corticosteroid use alone, there was no significant improvement in any long-term clinical outcome. These results indicate that anticholinergics should be the bronchodilator of choice in COPD, while beta-agonists may be associated with poorer disease control.

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Related in: MedlinePlus

Effect of anticholinergics compared with placebo on COPD hospitalizations, respiratory deaths and total deaths.Abbreviations: CI, confidence internal; COPD, chronic obstructive pulmonary disease; NDA, new drug application.
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f1-copd-2-11: Effect of anticholinergics compared with placebo on COPD hospitalizations, respiratory deaths and total deaths.Abbreviations: CI, confidence internal; COPD, chronic obstructive pulmonary disease; NDA, new drug application.

Mentions: The pooled results of 9 randomized placebo-controlled trials (Table 1) that ranged from three months to five years in duration (Salpeter, Buckley, Salpeter 2006) showed that anticholinergics reduced the risk of COPD hospitalizations by 30% and reduced respiratory deaths by 70%, compared with placebo (Figure 1). No significant effect on total mortality was seen (Salpeter and Buckley 2006). It is estimated that 58% of the participants were also taking concomitant inhaled corticosteroids.


Bronchodilators in COPD: impact of beta-agonists and anticholinergics on severe exacerbations and mortality.

Salpeter SR - Int J Chron Obstruct Pulmon Dis (2007)

Effect of anticholinergics compared with placebo on COPD hospitalizations, respiratory deaths and total deaths.Abbreviations: CI, confidence internal; COPD, chronic obstructive pulmonary disease; NDA, new drug application.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2692116&req=5

f1-copd-2-11: Effect of anticholinergics compared with placebo on COPD hospitalizations, respiratory deaths and total deaths.Abbreviations: CI, confidence internal; COPD, chronic obstructive pulmonary disease; NDA, new drug application.
Mentions: The pooled results of 9 randomized placebo-controlled trials (Table 1) that ranged from three months to five years in duration (Salpeter, Buckley, Salpeter 2006) showed that anticholinergics reduced the risk of COPD hospitalizations by 30% and reduced respiratory deaths by 70%, compared with placebo (Figure 1). No significant effect on total mortality was seen (Salpeter and Buckley 2006). It is estimated that 58% of the participants were also taking concomitant inhaled corticosteroids.

Bottom Line: In contrast, beta-agonist use had no effect on COPD hospitalizations and was associated with a two-fold increased risk for respiratory death compared with placebo.When the two bronchodilators were directly compared with each other, beta-agonists were associated with a two-fold increased risk for COPD hospitalization and a five-fold increased risk for total mortality compared with anticholinergics.When beta-agonists were added to either anticholinergic use or inhaled corticosteroid use alone, there was no significant improvement in any long-term clinical outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. salpeter@stanford.edu

ABSTRACT
This review summarizes the long-term clinical outcomes associated with beta-agonist and anticholinergic bronchodilator use in patients with chronic obstructive pulmonary disease (COPD). Pooled data from randomized placebo-controlled trials of at least three months duration were used to evaluate the risk for COPD hospitalizations, respiratory mortality, and total mortality. The results show that anticholinergic use is associated with a 30% reduction in COPD hospitalizations, a 70% reduction in respiratory mortality, and without a significant effect on total mortality. In contrast, beta-agonist use had no effect on COPD hospitalizations and was associated with a two-fold increased risk for respiratory death compared with placebo. When the two bronchodilators were directly compared with each other, beta-agonists were associated with a two-fold increased risk for COPD hospitalization and a five-fold increased risk for total mortality compared with anticholinergics. When beta-agonists were added to either anticholinergic use or inhaled corticosteroid use alone, there was no significant improvement in any long-term clinical outcome. These results indicate that anticholinergics should be the bronchodilator of choice in COPD, while beta-agonists may be associated with poorer disease control.

Show MeSH
Related in: MedlinePlus