COPD Drug Increases Risk of Death from Cardiovascular and Respiratory Events

Researchers Find a 34 Percent Increase in Mortality

The drug ipratropium bromide (trade name Atrovent), used in combination with albuterol hydrochloride in the medication Combivent, has been found to raise the risk of cardiovascular death by 34 percent in patients with chronic obstructive pulmonary disease (COPD). Researchers also found an increased risk of respiratory death associated with the medication theophylline: Both medications are used to treat COPD and are among just a handful of drugs approved by the federal Food and Drug Administration as COPD treatment.

The results are from a new study published in the Annals of Internal Medicine, September 16, 2008. The large-scale study used information on patients who were followed through the National Veterans Affairs inpatient, outpatient, pharmacy, and mortality databases; Centers for Medicare & Medicaid Services databases; and National Death Index Plus data from Oct. 1, 1999 through Sept. 30, 2003. They were followed through Sept. 30, 2004.

COPD is a chronic and life-threatening condition, which can drastically reduce a person's ability to breathe. In recent years there has been a great focus on developing drugs to treat this disease but no giant strides have yet been made, which further compounds the devastating results of this new study and potentially leaves patients with COPD even fewer treatment options.

Ipratropium belongs to a class of medications called anticholinergics, and acts as a bronchodilator. It is used to prevent wheezing, chest tightness, breathing difficulty, and coughing. It works by relaxing and opening the air passages to the lungs to make breathing easier. However, the drug is not without side effects. People are warned not to get the drug in their eyes. If they do, they could develop narrow angle glaucoma, which is a serious eye condition that may result in a person losing their eyesight. Worse, in people who already have narrow angle glaucoma, the condition could worsen. And, adding insult to injury, widened pupils, eye pain or redness, blurred vision and vision changes including seeing halos around lights are all possible if the drug gets in a person's eyes.

While this latest study was not looking at any of these side effects because they are established, the dramatic increased risk for cardiovascular death is new, and deeply alarming: So much so that scientists believe the results warrant further study. But at what cost? And would that be ethical? Who would be in this study, knowing the drug could increase their chances of dying of a heart attack?

As for theophylline, also known as dimethylxanthine, it has numerous side-effects, and so is no longer widely used. However, it is an approved COPD treatment. The investigators reported in their study: "Among medication regimens, those that included theophylline were associated with increased risk for respiratory death. For cardiovascular death, ipratropium alone and ipratropium plus theophylline were associated with increased risk, whereas the presence of inhaled corticosteroids with ipratropium reduced the risk for cardiovascular death."

SEPT-17-08: Risk for Death Associated with Medications for Recently Diagnosed Chronic Obstructive Pulmonary Disease [ ANNALS OF INTERNAL MEDICINE: COPD MEDICATIONS]

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Last updated on Sep-24-08