Evidence map›Paper›PMID 16970553›Full record

SynthesisJournal of general internal medicine2006

Meta-analysis: anticholinergics, but not beta-agonists, reduce severe exacerbations and respiratory mortality in COPD.

Shelley R Salpeter, Nicholas S Buckley, Edwin E Salpeter

Erratum issuedOpen access · bronzeAbstract readComparative StudyMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of general internal medicine, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 38 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 6 pooled it
14.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 6 syntheses or guidelines pooled it, 109 citations in OpenAlex.

  1. Pooled it
  2. Copd.BMJ clinical evidence · 2011
    Pooled it
  3. A systematic review of the cardiovascular risk of inhaled anticholinergics in patients with COPD.International journal of chronic obstructive pulmonary disease · 2009
    Pooled it
  4. Copd.BMJ clinical evidence · 2008
    Pooled it
  5. Pooled it
  6. Pooled it
  7. Trial
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  10. Article
  11. Article
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  13. Observational
  14. Article
  15. Article
  16. Article
  17. Article
  18. Acute lung failure.Seminars in respiratory and critical care medicine · 2011
    Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 3 institutions in 2 countries.

Shelley R SalpeterDepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USA. salpeter@stanford.edu
Nicholas S Buckley
Edwin E Salpeter
Cornell University · USSanta Clara Valley Medical Center · USSequoia (United States) · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnticholinergics and beta2-agonists have generally been considered equivalent choices for bronchodilation in chronic obstructive pulmonary disease (COPD).

objectiveTo assess the safety and efficacy of anticholinergics and beta2-agonists in COPD.

designWe comprehensively searched electronic databases from 1966 to December 2005, clinical trial websites, and references from selected reviews. We included randomized controlled trials of at least 3 months duration that evaluated anticholinergic or beta2-agonist use compared with placebo or each other in patients with COPD. MEASUREMENTS: We evaluated the relative risk (RR) of exacerbations requiring withdrawal from the trial, severe exacerbations requiring hospitalization, and deaths attributed to a lower respiratory event.

resultsPooled results from 22 trials with 15,276 participants found that anticholinergic use significantly reduced severe exacerbations (RR 0.67, confidence interval [CI] 0.53 to 0.86) and respiratory deaths (RR 0.27, CI 0.09 to 0.81) compared with placebo. Beta2-agonist use did not affect severe exacerbations (RR 1.08, CI 0.61 to 1.95) but resulted in a significantly increased rate of respiratory deaths (RR 2.47, CI 1.12 to 5.45) compared with placebo. There was a 2-fold increased risk for severe exacerbations associated with beta2-agonists compared with anticholinergics (RR 1.95, CI 1.39 to 2.93). The addition of beta2-agonist to anticholinergic use did not improve any clinical outcomes.

conclusionInhaled anticholinergics significantly reduced severe exacerbations and respiratory deaths in patients with COPD, while beta2-agonists were associated with an increased risk for respiratory deaths. This suggests that anticholinergics should be the bronchodilator of choice in patients with COPD, and beta2-agonists may be associated with worsening of disease control.

Indexed as

Adrenergic beta-AgonistsCholinergic AntagonistsHumansPulmonary Disease, Chronic ObstructiveRandomized Controlled Trials as TopicAdrenergic beta-AgonistsCholinergic Antagonists

Identifiers

PMID16970553
PMCPMC1831628
OpenAlexW2050359007

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.