title: Inhaled Long-acting Anticholinergics and Urinary Tract Infection in Individuals with COPD.
abstract: Inhaled, long-acting anticholinergic medication (LAA), commonly used for moderate-to-severe chronic obstructive pulmonary disease (COPD), has been shown to decrease COPD hospitalizations, emergency department visits, and acute exacerbations but has also been associated with urinary tract infection (UTI) in a prior meta-analysis. The objective of this study was to verify if there was an association between LAA and UTI in older individuals with COPD. A population-based, real-world cohort study using health administrative data from Ontario, Canada was conducted. Incidence of UTI was compared between older people with physician-diagnosed COPD, who were new users of inhaled long-acting anticholinergics and new users of inhaled corticosteroids-a reference medication used in similar clinical settings that has no known association with UTI. Propensity score matching was used to minimize the effects of confounding. An overall association between LAA and various measures of UTI in older individuals was not found. However, in a priori defined stratified analyses, men newly initiated on LAA were 75% more likely to develop a UTI than men newly started on an inhaled corticosteroid (hazard ratio 1.75; 95% confidence interval 1.05-2.92). No significant association was seen in women. In conclusion, older men with COPD newly started on LAA are at increased risk of UTI. Men considering an inhaled LAA should be informed of this risk and, if they decide to take it, be provided with appropriate monitoring.
authors.affiliation: a Sunnybrook Research Institute, Sunnybrook Health Sciences Centre , Toronto , Ontario , Canada.|b Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|c Department of Medicine , Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada.|d Institute of Health Policy, Management, and Evaluation, University of Toronto , Toronto , Ontario , Canada.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Gershon
authors.affiliation: b Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Newman
authors.affiliation: b Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.
authors.forename: Hadas D
authors.initials: HD
authors.lastname: Fischer
authors.affiliation: b Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|d Institute of Health Policy, Management, and Evaluation, University of Toronto , Toronto , Ontario , Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: a Sunnybrook Research Institute, Sunnybrook Health Sciences Centre , Toronto , Ontario , Canada.|b Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|c Department of Medicine , Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Daneman
authors.affiliation: b Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|c Department of Medicine , Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada.|d Institute of Health Policy, Management, and Evaluation, University of Toronto , Toronto , Ontario , Canada.|e Department of Medicine , Mount Sinai Hospital , Toronto , Ontario , Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: c Department of Medicine , Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada.|f Division of Respirology , Department of Medicine, St Michael's Hospital , Toronto , Ontario , Canada.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Stephenson
authors.affiliation: b Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|g Department of Medicine , Queen's University , Kingston , Ontario , Canada.
authors.forename: Sudeep S
authors.initials: SS
authors.lastname: Gill
authors.affiliation: c Department of Medicine , Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada.|f Division of Respirology , Department of Medicine, St Michael's Hospital , Toronto , Ontario , Canada.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Vozoris
authors.affiliation: b Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|c Department of Medicine , Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada.|d Institute of Health Policy, Management, and Evaluation, University of Toronto , Toronto , Ontario , Canada.|h Women's College Research Institute, Women's College Hospital , Toronto , Ontario , Canada.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009864:Ontario / Q000453:epidemiology; D057216:Propensity Score; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012307:Risk Factors; D012737:Sex Factors; D014552:Urinary Tract Infections / Q000453:epidemiology*
chemical_list: D000305:Adrenal Cortex Hormones; D018680:Cholinergic Antagonists; D003692:Delayed-Action Preparations
keywords: Medication; adverse events; health outcomes; infection