Chronic obstructive pulmonary disease is the third leading cause of death in the United States and is one of the only major diseases for which the mortality rate is rising.1 Apart from respiratory causes, the major causes of death among patients with COPD include cardiovascular death and infectious complications, such as pneumonia. The SAAC ipratropium and LAAC tiotropium and the long-acting β2-agonist inhaled corticosteroid combination inhalers are approved for use in the United States. The benefits of IACs include their ability to provide symptomatic relief, to reduce exacerbations (by approximately 13%-25%), and to modestly improve forced expiratory volume in the first second of expiration. However, none of the marketed agents slow the progressive decline of the latter measure over time or improve survival. Therefore, information on serious adverse effects associated with IACs can potentially alter their benefit-harm assessment.
Singh S, Furberg CD. Inhaled Anticholinergics for Chronic Obstructive Pulmonary DiseaseComment on “Inhaled Anticholinergic Drug Therapy and the Risk of Acute Urinary Retention in Chronic Obstructive Pulmonary Disease”. Arch Intern Med. 2011;171(10):920-922. doi:10.1001/archinternmed.2011.171