title: The effects of inhaled respiratory drugs on the risk of stroke: A nested case-control study.
abstract: Although there have been concerns that inhaled long-acting muscarinic antagonists increase the risk of stroke, controversies exist. We investigated whether respiratory drugs including long-acting muscarinic antagonists are associated with the risk of stroke. A nested case-control study using the nationwide insurance claims database of the Health Insurance Review and Assessment Service (Seoul, Republic of Korea) was conducted. Overall, 16,354 stroke cases and 74,451 matched (up to 1:5) controls were identified from 809,684 subjects without acute major cardiovascular events in the past year between January 1, 2010, and December 31, 2011. To determine whether the use of inhaled respiratory drugs is associated with the risk of stroke, conditional logistic regression analysis adjusted by comorbidities, cardiovascular drugs and healthcare utilization was performed. After adjusting for covariates, there were no statistically significant effects of the inhaled drugs on stroke incidence, except for inhaled corticosteroids without a long-acting β2-agonists, which was significantly associated with hemorrhagic stroke. Inhaled respiratory medications, including long-acting muscarinic antagonists, did not affect the risk of stroke in the inhaled respiratory drug users.
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Chang-Hoon
authors.initials: CH
authors.lastname: Lee
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Department of Statistics, Kyungpook National University College of Natural Sciences, Daegu, Republic of Korea.
authors.forename: Seongmi
authors.initials: S
authors.lastname: Choi
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Department of Information Statistics, Colloge of Natural Science, Andong National University, Andong, Republic of Korea.
authors.forename: Eun Jin
authors.initials: EJ
authors.lastname: Jang
authors.affiliation: Department of Neurology, College of Medicine, Konkuk University, Seoul, Republic of Korea.
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Kim
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea.
authors.forename: Ho Il
authors.initials: HI
authors.lastname: Yoon
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
authors.forename: Yun Jung
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
authors.forename: Jimin
authors.initials: J
authors.lastname: Kim
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jae-Joon
authors.initials: JJ
authors.lastname: Yim
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea. Electronic address: kimdkmd@gmail.com.
authors.forename: Deog Kyeom
authors.initials: DK
authors.lastname: Kim
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D056910:Republic of Korea; D012189:Retrospective Studies; D020521:Stroke / Q000139:chemically induced* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018727:Muscarinic Antagonists
keywords: Drug; Epidemiology; Inhaled corticosteroids; Inhaled muscarinic antagonists; Inhaled β(2)-agonists; Stroke