ArticleBMJ open2012
A new user cohort study comparing the safety of long-acting inhaled bronchodilators in COPD.
Article in BMJ open, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Evaluating Arrhythmia Risk in Patients with Chronic Obstructive Pulmonary Disease Treated with Aclidinium/Formoterol Fumarate and Other Inhaled Bronchodilators: A Post-Authorization Safety Study.International journal of chronic obstructive pulmonary disease · 2026Article
- Use of nebulized bronchodilators in acute heart failure: impact on outcomes.Internal and emergency medicine · 2025Article
- Risk Assessment of Acute Myocardial Infarction and Stroke Associated with Long-Acting Muscarinic Antagonists, Alone or in Combination, versus Long-Acting beta2-Agonists.International journal of chronic obstructive pulmonary disease · 2022Article
- Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice?BMJ open respiratory research · 2021Article
- One-year mortality associated with COPD treatment: a comparison of tiotropium and long-acting beta2-agonists in three Italian regions: results from the OUTPUL study.Pharmacoepidemiology and drug safety · 2016Article
- Randomized controlled trials and real-world observational studies in evaluating cardiovascular safety of inhaled bronchodilator therapy in COPD.International journal of chronic obstructive pulmonary disease · 2016Observational
- Observational
- Clinical potential of aclidinium bromide in chronic obstructive pulmonary disease.International journal of chronic obstructive pulmonary disease · 2015Review
- Defining COPD-Related Comorbidities, 2004-2014.Chronic obstructive pulmonary diseases (Miami, Fla.) · 2014Review
- Article
- The pharmacological approach to the elderly COPD patient.Drugs & aging · 2013Review
- Risk of acute urinary retention associated with inhaled anticholinergics in patients with chronic obstructive lung disease: systematic review.Therapeutic advances in drug safety · 2013Article
- Ten years of tiotropium: clinical impact and patient perspectives.International journal of chronic obstructive pulmonary disease · 2013Review
- The Utilization and Safety of Umeclidinium and Umeclidinium/Vilanterol in UK Primary Care: A Retrospective Cohort Study.International journal of chronic obstructive pulmonary diseaseObservational
- A Cohort Study to Evaluate the Risk of Hospitalisation for Congestive Heart Failure Associated with the Use of Aclidinium and Other Chronic Obstructive Pulmonary Disease Medications in the UK Clinical Practice Research Datalink.International journal of chronic obstructive pulmonary diseaseArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate a possible increased risk observed in tiotropium clinical trials of stroke and other adverse events.
designNew users of long-acting anticholinergic therapy (tiotropium HandiHaler®) were compared with new users of long-acting β-agonist (LABA) monotherapy, and propensity scores were used to control confounding.
settingUK healthcare system general practitioner electronic medical record database.
participants10 840 patients newly prescribed tiotropium (n=4767) or LABA (n=6073), at least 40 years old, and not having asthma as their only respiratory illness. PRIMARY AND SECONDARY OUTCOME MEASURES: Incidence rates of total stroke, myocardial infarction, angina and other adverse events.
resultsTiotropium was associated with increased rates of stroke (HR=1.49, 95% CI 0.91 to 2.45), angina (HR=1.38, 95% CI 0.88 to 2.16) and myocardial infarction (HR=1.26, 95% CI 0.72 to 2.21). Groups had similar rates of chronic obstructive pulmonary disease exacerbation (HR=0.95, 95% CI 0.80 to 1.12) and pneumonia (HR=0.96, 95% CI 0.58 to 1.58). Tiotropium was associated with a lower rate of total mortality (HR=0.70, 95% CI 0.56 to 0.89) and asthma exacerbations (HR=0.46, 95% CI 0.36 to 0.57) than users of LABA.
conclusionSmall increased risks of serious ischaemic cardiovascular events have been reported with inhaled anticholinergic medication from randomised and nonrandomized studies of ipratropium, tiotropium HandiHaler® and tiotropium Respimat®. Additional research is needed to understand the full extent of cardiovascular effects of inhaled anticholinergic medications and the patients who may be most susceptible.
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Registered trials
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.