title: Comparison of tiotropium bromide and combined ipratropium/salbutamol for the treatment of COPD: a UK General Practice Research Database 12-month follow-up study.
abstract: OBJECTIVE
  To compare the effectiveness of the long-acting anticholinergic, tiotropium with ipratropium/salbutamol in reducing the risk of exacerbations and COPD-related referrals in patients with COPD.
  
  
  METHODS
  Data were obtained from the General Practice Research Database (GPRD). Propensity score matching was used to balance prognostic covariates between treatment groups. Incidence rate ratios and 95% confidence intervals during a 12-month follow-up period were estimated.
  
  
  RESULTS
  4193 patients (3385, tiotropium; 808, ipratropium/salbutamol) in the GPRD met the inclusion/exclusion criteria. Patients treated with tiotropium had more severe COPD than patients treated with ipratropium/salbutamol. Following propensity score matching, 1222 tiotropium-treated patients and 633 ipratropium/salbutamol-treated patients were included in the final analysis. Incidence rate ratios (95% confidence intervals) were 0.74 (0.64-0.85; p=0.0086) for exacerbations and 0.57 (0.46-0.70; p=0.004) for COPD-related referrals/hospitalisations.
  
  
  CONCLUSIONS
  Tiotropium is associated with a reduced risk of exacerbations and COPD-related referrals and hospitalisation compared to combined ipratropium/salbutamol in patients with COPD.
authors.affiliation: Health Economics & Outcomes Research, Boehringer Ingelheim Limited, Bracknell, Berkshire, RG12 8YS, UK. jane.griffin@boehringer-ingelheim.com
authors.forename: Jane
authors.initials: J
authors.lastname: Griffin
authors.forename: Sally
authors.initials: S
authors.lastname: Lee
authors.forename: Maria
authors.initials: M
authors.lastname: Caiado
authors.forename: Steven
authors.initials: S
authors.lastname: Kesten
authors.forename: David
authors.initials: D
authors.lastname: Price
mesh_terms: D000368:Aged; D000420:Albuterol / Q000627:therapeutic use*; D000068600:Albuterol, Ipratropium Drug Combination; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D009241:Ipratropium / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012602:Scopolamine Derivatives / Q000627:therapeutic use*; D000069447:Tiotropium Bromide; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000068600:Albuterol, Ipratropium Drug Combination; D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D009241:Ipratropium; D000420:Albuterol; D000069447:Tiotropium Bromide