Journal ArticleDOI
Inhaled Anticholinergics and Risk of Major Adverse Cardiovascular Events in Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis
TLDR
Inhaled anticholinergics are associated with a significantly increased risk of cardiovascular death, MI, or stroke among patients with COPD.Abstract:
Context Inhaled anticholinergics (ipratropium bromide or tiotropium bromide) are widely used in patients with chronic obstructive pulmonary disease (COPD) but their effect on the risk of cardiovascular outcomes is unknown. Objective To ascertain the cardiovascular risks of inhaled anticholinergics, including cardiovascular death, myocardial infarction (MI), and stroke. Data Sources Systematic searches were conducted on March 19, 2008, of relevant articles in MEDLINE, the Cochrane Database of systematic reviews, regulatory authority Web sites in the United States and the United Kingdom, and manufacturers' trial registries with no date restrictions. Study Selection Randomized controlled trials of any inhaled anticholinergic for treatment of COPD that had at least 30 days of treatment and reported on cardiovascular events. Data Extraction The primary outcome was a composite of cardiovascular death, MI, or stroke. The secondary outcome was all-cause mortality. Relative risks (RRs) were estimated using fixed-effects models and statistical heterogeneity was estimated with the I2 statistic. Data Synthesis After a detailed screening of 103 articles, 17 trials enrolling 14 783 patients were analyzed. Follow-up duration ranged from 6 weeks to 5 years. Cardiovascular death, MI, or stroke occurred in 135 of 7472 patients (1.8%) receiving inhaled anticholinergics and 86 of 7311 patients (1.2%) receiving control therapy (RR, 1.58 [95% confidence interval {CI}, 1.21-2.06]; P 6 months) confirmed the significantly increased risk of cardiovascular death, MI, or stroke (2.9% of patients treated with anticholinergics vs 1.8% of the control patients; RR, 1.73 [95%CI, 1.27-2.36]; P Conclusion Inhaled anticholinergics are associated with a significantly increased risk of cardiovascular death, MI, or stroke among patients with COPD.read more
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Journal ArticleDOI
Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society
Amir Qaseem,Timothy J Wilt,Steven E. Weinberger,Nicola A. Hanania,Gerard J. Criner,Thys van der Molen,Darcy D. Marciniuk,Tom Denberg,Holger J. Schünemann,Wisia Wedzicha,Roderick MacDonald,Paul G. Shekelle +11 more
TL;DR: The value of history and physical examination for predicting airflow obstruction; the value of spirometry for screening or diagnosis of COPD; and COPD management strategies, specifically evaluation of various inhaled therapies, pulmonary rehabilitation programs, and supplemental oxygen therapy are addressed.
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Chronic obstructive pulmonary disease
TL;DR: The main cause is smoking tobacco, but other factors have been identified as mentioned in this paper, such as genetic determinants, lung growth, and environmental stimuli, which is further aggravated by exacerbations, particularly in patients with severe disease.
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Pharmacology and Therapeutics of Bronchodilators
TL;DR: An important step in simplifying asthma and COPD management and improving adherence with prescribed therapy is to reduce the dose frequency to the minimum necessary to maintain disease control, so the incorporation of once-daily dose administration is an important strategy to improve adherence.
Journal ArticleDOI
Dual bronchodilation with QVA149 versus single bronchodilator therapy: the SHINE study
Eric D. Bateman,Gary T. Ferguson,Neil Barnes,Nicola Gallagher,Yulia Green,Michelle Henley,Donald Banerji +6 more
TL;DR: Dual bronchodilation with once-daily QVA149 demonstrated superior and clinically meaningful outcomes versus placebo and superiority versus treatment with a single Bronchodilator, with a safety and tolerability profile similar to placebo, supporting the concept of fixed-dose long-acting muscarinic antagonist/long-acting &bgr;2-agonist combinations for the treatment of COPD.
Journal ArticleDOI
Single-Center Trials Show Larger Treatment Effects Than Multicenter Trials: Evidence From a Meta-epidemiologic Study
TL;DR: A meta-epidemiologic study to evaluate whether estimates of treatment effect differ between single-center and multicenter randomized, controlled trials (RCTs), finding that single- center RCTs showed larger treatment effects than did multicenter R CTs, a finding that was consistent in all sensitivity analyses.
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