Is there any association between inhaled ipratropium and mortality in patients with COPD and asthma?
BACKGROUND
To determine whether ipratropium was associated with premature death in patients with asthma and chronic obstructive pulmonary disease (COPD).


METHODS
A longitudinal cohort of 827 patients with COPD and 273 with asthma who were evaluated for compensation by two specialists in pulmonary medicine.


RESULTS
By June 1999, 538 of the patients with COPD and 77 of those with asthma had died. Atthe consultation, 77% ofthe COPD patients and 8.1% of the asthmatic patients were treated with inhaled ipratropium. Ipratropium was associated with mortality risk ratio (RR) of 2.0 (95% confidence interval: 1.5-2.6) for COPD and 3.6 (1.8-7.1) for asthma patients. After adjustment for confounding factors [forced expiratory volume 1 s (FEV1), smoking habits, asthma medication, and presence of cor pulmonale] the RR for COPD was 1.6 (1.2-2.1) and for asthma 24 (1.2-5.0).


CONCLUSIONS
The increased risk of premature death associated with ipratropium is of concern and necessitates further evaluation, e.g., in a randomised study.
Ringbaek
T
T
Department of Pulmonary Medicine, University Hospital of Copenhagen, Hvidovre, Denmark. ringbaek@dadlnet.dk
Viskum
K
K
D000280:Administration, Inhalation; D001249:Asthma / Q000188:drug therapy* / Q000401:mortality; D015992:Body Mass Index; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D014797:Vital Capacity / Q000187:drug effects
D001993:Bronchodilator Agents; D009241:Ipratropium