title: Survival with tiotropium compared to long-acting Beta-2-agonists in Chronic Obstructive Pulmonary Disease.
abstract: Chronic Obstructive Pulmonary Disease (COPD) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase. Tiotropium has been shown to reduce exacerbations, hospitalizations, symptoms, and improve health-related quality of life in patients with COPD. Its effect on mortality and its effects relative to long-acting beta-agonists (LABAs), however, remain unknown. To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD, a longitudinal, population-based cohort study was conducted in Ontario, Canada. Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1, 2003 and March 31, 2006. The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge, controlling for a number of potential confounders, was eliminated. Data from 7218 eligible patients were analyzed. Of these, 1046 (14.5%) died in the follow-up period. Patients who received tiotropium were 20% less likely to die than those receiving a long-acting beta-agonist (hazard ratio 0.80, 95% confidence interval 0.70 to 0.93). In conclusion, in older patients recently discharged from hospital for COPD, receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agonist. This result suggests that tiotropium might also be associated with decreased mortality compared to no treatment at all. Randomized placebo-control trials are needed to confirm these findings.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. andrea.gershon@utoronto.ca
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Gershon
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.forename: Jin
authors.initials: J
authors.lastname: Luo
authors.forename: Ross E G
authors.initials: RE
authors.lastname: Upshur
mesh_terms: D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002423:Cause of Death; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D009864:Ontario; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D012042:Registries; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012602:Scopolamine Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide