Anticholinergics linked to urinary retention in men with COPD
MedWire News: The use of inhaled anticholinergic (IAC) drugs is associated with an increased risk for urinary retention in men, but not women, with chronic obstructive pulmonary disease (COPD), study results suggest.
"Physicians and the public need to be aware of the potential for this significant adverse event, so that preventive measures and potential therapy can be considered," say Anne Stephenson (St Michael's Hospital, Toronto, Ontario, Canada) and team.
IACs are widely used in the treatment of COPD patients. They work through local muscarinic receptor blockade, causing relaxation of airway smooth muscle and decreased airflow obstruction.
However, the team says that "the systemic anticholinergic effects of IAC therapy have not been extensively studied."
To investigate whether IAC use is associated with acute urinary retention (AUR), as has previously been suggested, Stephenson and colleagues used Ontario's universal health insurance program to identify 565,073 individuals aged 66 years or older who were treated for COPD between 2003 and 2009.
IAC use among these patients was determined using data from the Ontario Drug Benefit database, while the Canadian Institute for Health Information Discharge Abstracts database, the Same-Day Surgery database, and the National Ambulatory Care Reporting System database were used to determine AUR rates among the patients.
In total, 9432 men and 1806 women with COPD developed AUR during the study period.
The researchers found that men with COPD taking IACs were at increased risk for developing AUR, whereas this relationship was not statistically significant in women.
After accounting for factors such as age and history of prostate cancer, the researchers found that men who were new users of IACs were at a significant 1.42-fold increased risk for AUR, while those who were current users had a 1.36-fold increased risk for the condition, compared with those who had never used IACs.
Men with COPD who were past users of IACs were no more likely to develop AUR than those who had never used these medications.
"The use of short- and long-acting IACs is associated with an increased risk of AUR in men with COPD," the team concludes in the Archives of Internal Medicine.
In an accompanying commentary, Sonal Singh (Johns Hopkins University, Baltimore, Maryland, USA) and Curt Furberg (Wake Forest University, Winston-Salem, North Carolina, USA) say that IACs do not completely stall the progress of COPD or improve mortality, "therefore, information on serious adverse effects associated with IACs can potentially alter their benefit-harm assessment."
They add: "Physicians should inform patients with COPD about the risk of AUR associated with IACs and determine the optimal choice of therapy for their patients after eliciting patient preferences for various patient-oriented outcomes in a shared decision-making context."
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By Mark Cowen