title: Comparison of inhaled long-acting β-agonist and anticholinergic effectiveness in older patients with chronic obstructive pulmonary disease: a cohort study.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD), a largely preventable and manageable respiratory condition, affects an estimated 12% to 20% of adults. Long-acting inhaled β-agonists and anticholinergics have both been shown to improve COPD outcomes and are recommended for moderate to severe disease; however, little is known about their comparative effectiveness.
  
  
  OBJECTIVE
  To compare survival in older patients with COPD who initially receive inhaled long-acting β-agonists with that of patients who receive anticholinergics.
  
  
  METHODS
  Population-based, retrospective cohort study.
  
  
  METHODS
  Ontario, Canada.
  
  
  METHODS
  Patients aged 66 years or older (who carry the largest burden of COPD and for whom data were available) who met a validated case definition of COPD on the basis of health administrative data and were newly prescribed an inhaled long-acting β-agonist or a long-acting anticholinergic (but not both) between 2003 and 2007. Patients were followed for up to 5.5 years.
  
  
  METHODS
  The primary outcome was all-cause mortality.
  
  
  RESULTS
  A total of 46 403 patients with COPD (mean age, 77 years; 49% women) were included. Overall mortality was 38.2%. Mortality was higher in patients initially prescribed a long-acting anticholinergic than in those initially prescribed a long-acting inhaled β-agonist (adjusted hazard ratio, 1.14 [95% CI, 1.09 to 1.19]). Rates of hospitalizations and emergency department visits were also higher in those initially prescribed a long-acting anticholinergic.
  
  
  CONCLUSIONS
  Patients were classified as having COPD on the basis of health administrative records, which did not contain information about lung function.
  
  
  CONCLUSIONS
  Older adults initially prescribed long-acting inhaled β-agonists for the management of moderate COPD seem to have lower mortality than those initially prescribed long-acting anticholinergics. Further research is needed to confirm these findings in younger patients and in a randomized, controlled trial.
  
  
  BACKGROUND
  Government of Ontario, Canada.
authors.affiliation: Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gershon
authors.forename: Ruth
authors.initials: R
authors.lastname: Croxford
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Stanbrook
authors.forename: Ross
authors.initials: R
authors.lastname: Upshur
authors.forename: Paula
authors.initials: P
authors.lastname: Sanchez-Romeu
authors.forename: Thérèse
authors.initials: T
authors.lastname: Stukel
mesh_terms: D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002423:Cause of Death; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D057216:Propensity Score; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists