Comparison of therapies in older patients with COPD

January 01, 0001

Comparison of therapies in older patients with COPD

Long-acting inhaled beta-agonists and anticholinergics have both been shown to improve COPD outcomes and are recommended for moderate to severe disease. The aim of this population-based, retrospective cohort study by researchers from Canada was to compare survival in older patients with COPD who initially receive inhaled long-acting beta- agonists with that of patients who receive anticholinergics. 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 beta-agonist or a long- acting anticholinergic (but not both) between 2003 and 2007 were recruited and followed for up to 5.5 years. 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 beta-agonist (adjusted hazard ratio, 1.14). Rates of hospitalizations and emergency department visits were also higher in those initially prescribed a long-acting anticholinergic.

The researchers concluded: "Older adults initially prescribed long-acting inhaled beta-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."

Yes, further research is needed, but worth noting.

For the full abstract, click here.

Annals of Internal Medicine 154(9):583-592, 2 May 2011
© 2011 by the American College of Physicians
Anticholinergic Effectiveness in Older Patients With Chronic Obstructive Pulmonary Disease. Andrea Gershon, MD, MSc; Ruth Croxford, MSc, PStat; Teresa To et al.

Category: R. Respiratory. Keywords: long acting beta-agonist, anticholinergic, comparison, effectiveness, older, chronic obstructive pulmonary disease, COPD, population-based retrospective cohort study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 10 June 2011

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