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COPD patients taking long-acting bronchodilators need 'close monitoring'

GPs should ‘closely monitor’ patients with COPD who are taking long-acting bronchodilators due to an increased risk of cardiovascular disease, say researchers.

The study

Researchers conducted a nested case-control study using administrative data from Ontario, Canada, for nearly 200,000 patients aged 66 years or older who were undergoing treatment for COPD from September 2003 to the end of March 2009. They looked at new use of an inhaled LABA or long-acting muscarinic antagonist (LAMA) and the main outcome of the study was a hospital or emergency department visit for a cardiovascular event.

The findings

Newly prescribed LABAs and LAMAs were associated with significant 31% and 14% increased relative risks of cardiovascular events, respectively, compared with no use of these drugs. The researchers found no difference in the increase in cardiovascular event risk between the two types of bronchodilator. Secondary analysis showed that new use of LABAs and LAMAs increased the risk of acute coronary syndrome and heart failure, but not arrhythmia or stroke, compared with no use.

What this means for GPs

The authors concluded: ‘We found that new users of LABAs and [LAMAs] in a population-based study of older individuals with COPD had similar but increased risk of cardiovascular events. These results support the need for close monitoring of all patients with COPD who require long-acting bronchodilators regardless of drug class.’

Expert view

Dr Kevin Gruffydd-Jones, RCGP respiratory clinical lead and a GP in Box, Wiltshire: ‘What we do know is that these drugs improve symptoms and quality of life and reduce the risk of acute exacerbations. So these findings are not enough to say we should change our prescribing but we do need to be aware of the potential risk and remember to carefully monitor patients’ cardiovascular risk factors, such as blood pressure and cholesterol, as well as their respiratory measures.’

JAMA Intern Med 2013; available online 20 May

Readers' comments (1)

  • If the control group for comparison had COPD and were not on a LAMA or LABA, then surely their disease staging was early compared to the group that presented with a cardiovascular event. Can this be correlated to a lower Q risk? Need more information on this study to make a valid judgement on it's value in primary care.

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