Lack of association between ipratropium bromide and mortality in elderly patients with chronic obstructive airway disease
Don D Sina c, Jack V Tua b
a Institute for
Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada, b Department of Medicine,
Sunnybrook and Women's College Health Science Center, University of
Toronto, Toronto, Ontario, Canada, c Department of Medicine, University of Alberta,
Edmonton, Alberta, Canada
Correspondence to: Dr J V Tu, Institute for Clinical Evaluative Sciences, G106-2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
Received 19 July 1999; Returned to authors 13 September 1999; Revised version received 25 November 1999; Accepted for publication 7 December 1999
BACKGROUND
Ipratropium
is commonly used for the management of elderly patients with
obstructive airway disease. However, a recent report suggested that its
use might be associated with a significant increase in mortality. A
study was therefore conducted to compare all-cause mortality rates
between users and non-users of ipratropium in elderly patients with
either asthma or chronic obstructive pulmonary disease (COPD).
METHODSA
retrospective cohort study was performed using linked data from the
Canadian Institute for Health Information, the Ontario Drug Benefit
Program, the Ontario Health Insurance Plan, and the Ontario Registered
Persons database. A total of 32 393 patients were identified who were
aged 65 years or older and who had been discharged from hospital with
asthma or COPD between 1 April 1992 and 31 March 1997. All-cause
mortality rates were compared between those treated and those not
treated with ipratropium following discharge from hospital.
RESULTSIn total, 49%
of patients received ipratropium within 90 days of discharge. After
adjusting for age, sex, comorbidity, use of health services, and other
airway medications there was no significant association in patients
with COPD between the use of ipratropium and mortality (relative risk
(RR) 1.03; 95% confidence interval (CI) 0.98 to 1.08). In patients
with asthma, however, there was a slight increase in the relative risk
of mortality associated with the use of ipratropium (RR 1.24; 95% CI
1.11 to 1.39). A dose-response increase in the mortality rate was not observed with increasing use of ipratropium in either COPD or asthma.
CONCLUSIONSThe use of
ipratropium in patients with COPD was not associated with an increase
in mortality. However, in asthma there was a small increase in the
mortality rate. Since asthmatic patients who received ipratropium had
greater use of other airway medications and health services, the
difference in mortality rate between users and non-users may be a
reflection of unmeasured differences in asthma severity.
Keywords: ipratropium; mortality; asthma; chronic obstructive pulmonary disease
© 2000 by Thorax
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