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Double-edged Sword?  Long-Acting Bronchodilators in Chronic Obstructive Pulmonary Disease

Prescott G. Woodruff, MD, MPH1
[+] Author Affiliations
1Cardiovascular Research Institute and Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2013;173(13):1184-1185. doi:10.1001/jamainternmed.2013.1201.
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No pharmacotherapy has been shown to meaningfully alter the rate of progression of chronic obstructive pulmonary disease (COPD). However, inhaled long-acting bronchodilators are mainstays of treatment in moderate to severe COPD because they improve lung function, dyspnea, rate of exacerbations, and quality of life.

Nonetheless, their use has been clouded by concerns regarding the cardiovascular risks of these medications. Gershon et al1 address this controversy using a case-control analysis nested in a retrospective cohort. Cases and controls were selected from 191 005 subjects 66 years or older who met a validated case definition of COPD. Cases were subjects newly prescribed long-acting inhaled β-agonists (LABAs) and muscarinic antagonists (LAMAs; termed long-actinganticholinergics by Gershon et al), and controls were matched for prognostic factors. Overall, 28.0% of subjects had a primary outcome event, defined as an emergency department visit or a hospitalization for a cardiovascular event. Newly prescribed LABAs and LAMAs were associated with increased risk of a cardiovascular event, but no difference in risk between the 2 medications was found. The authors recommend close monitoring of patients with COPD requiring long-acting bronchodilators regardless of drug class.

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