LABA and LAAs Update to research

Elderly patients suffering from chronic obstructive pulmonary disease (COPD) who are treated with long-acting bronchodilators ß-agonists and anticholinergics are at an increased risk of cardiovascular events, according to new research published in the journal JAMA Internal Medicine.

Over a quarter of Americans above the age of 35 suffer from COPD, it is one of the leading causes of death in the country. In fact, according to a previous study published in The Lancet, one out of four individuals aged 35 and over is likely to develop COPD at some stage of their lives.

COPD is a chronic disease that makes it hard for the patient to breathe - there is a lot coughing. The disease generally gets worse with time.

As background information, the authors wrote that the use of long-acting ß-agonists (LABAs) and long-acting anticholinergics (LAAs) is somewhat controversial because of the cardiovascular health risks associated with their usage.

In an invited commentary, Prescott G. Woodruff, M.D., M.P.H., of the University of California, San Francisco, said:

"No pharmacotherapy has been shown to meaningfully alter the rate of progression of chronic obstructive pulmonary disease (COPD). However, inhaled long-acting bronchodilators are mainstays of treatment in moderate to severe COPD because they improve lung function, dyspnea [shortness of breath], rate of exacerbations and quality of life."

Researchers from the Institute for Clinical Evaluative Sciences, Ontario, Canada, led by Andrea Gershon, M.D., M.S., carried out a case control analysis of a retrospective cohort study that identified the risk of cardiovascular complications among patients taking inhaled long-acting medications.

They used health care databases from Ontario which included all patients over the age of 66 who were diagnosed with COPD between 2003 and 2009. 53,532 of the 191,005 eligible patients were hospitalized or reported a emergency department visit or for a cardiovascular complication.

Results of the study revealed that a higher risk of cardiovascular events was associated with newly prescribed long-acting inhaled bronchodilators ß-agonists and anticholinergics compared to nonuse of the medications.

The authors of the study concluded:

"Among older individuals with COPD, new use of long-acting ß-agonists and anticholinergics is associated with similar increased risks of cardiovascular events. Close monitoring of COPD patients requiring long-acting bronchodilators is needed regardless of drug class."

A similar finding wa published in the September 24, 2008 issue of the Journal of the American Medical Association, JAMA. Researchers published evidence on the widely prescribed anticholinergics ipratropium bromide and tiotropium bromide (marketed as Atrovent and Spiriva), and found they were associated with an increased risk of cardiovascular death, heart attack and stroke among COPD patients.

Written by Joseph Nordqvist

16 Replies

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  • That REALY cheered me up!!

  • I have just started taking Spiriva and found it a great help.

  • Thanks for this info- it will spur me on to remain as fit as I possibly can be- not withstanding COPD for almost last 10 years!

    Have a great day everyone !

  • thanks for the info I do believe if we all keep informed it is a good thing because no GP can read all that we can and if they listen it has got to move the treatment on,

    cheers

    Richard

  • Clinical trial of One: Me

    I always thought my lungs would finish me off in the end,(lifelong asthmatic, recurrent chest infections, alpha 1, 10years COPD) - then my heart joined in!!!!!!! (actually my heart is fine BUT the plumbing needed sorting - quad bipass in Jan)

    Point of Interest is the 'Everything is linked!!!'

    Enjoy the Day and like PollyP I intend to keep as fit as I can. Exercise is a way of life!!

    ATB

    Kevin

  • I also that my lungs would finish me off after having bronchitis the whole time aged 3 to about 10 so I missed school. Luckily my Gran (she lived with us) had been an infant school teacher and she taught me to read and write!

    Like you, I'm a lifelong asthmatic too, but I haven't got alpha 1 or COPD.

    TOTALLY AGREE that everything is linked. Body, mind and everything within those. Whoever split the mind and body was a nincompoop. Yes, I know it was one of those early philosophers whose name I forget.

    Take care

    koala

  • Rene Descartes was one of these culprits, he supposedly came up with the 'I think therefore I am' palava

    I heard this joke a long time ago, I know it's a bit highbrow but it is the only Descartes joke I know. I hope you think it appropriate.

    Descartes walks into a bar.

    The bartender walks up to him and says, “Would you care for a drink?”

    Descartes replied, “I think not.” and disappears.

    Have fun and enjoy the day

    Kevin

  • Haha :-)

    Yes, he's the one I was thinking of and his dualism cr@p.

    "Palava", haha good description.

    Hope you have a fun day too.

    koala aka Maria

  • Thanks for that Martin. I am now going to the pub to get drunk and chase wimmin. Might as well enjoy what little time I have left. lol. Seriously though, that was very interesting.

    Bobby

  • find it hard to believe %25 of over 35's in america suffer from COPD thats about twenty million people

  • That statistic made me wonder too, sounds like a mistake or misprint, doesn't it?

    Although maybe they are including a wide range of things under the umbrella term COPD along with a wide range of severity.

    If you include other lung disorders perhaps you'd get 25% I don't know, certainly if it's emphysema and chronic bronchitis alone then that percentage is shockingly high.

  • I have thought for a long time that a drug for one condition can lead to another. Dont intend to stop using my medication-feel uncomfortable if I am late taking them..

  • Oh dear :( . I'm a relative COPD newbie and Ventolin didn't suit so I've been put on Spiriva. There is a really bad heart history on both sides of my family and during investigations into my breathlessness I was referred to a consultant cardiologist who found I have either a leaking or blocked valve. As my GP surgery is right at the top of the scale of hopelessness then reading this isn't the best start to the day :( .

  • LABAs aren't good for us, I certainly believe that. From what I've read, it is African Americans who are at most risk but I can't imagine they are good for any of us, they affect the heart.

    Even short acting beta agonists make my heart race and I get shaky.

    But what can we do? they don't seem to have developed sprays yet that relax bronchial muscles without affecting the heart.

  • I don't drink, I don't smoke,I don't,I don,t,I don,t but I am still here 17 years on.

  • OH GOOD my heart troubles started 2 weeks after I was started on Spiriva. I was rushed to hospital with a pulse rate of 240 bpm, which had lasted for 12 hours very scary. 1 week later came home with about 5 more drugs to take each day and nobody said anything about a possible link to the chest meds I was taking. Why is there nver any doctor who will look at the whole picture and not just his bit. I did smoke then so of couse that was the answer to everything ( i have stopped now and I can tell the docs are almost sorry not to have some thing to blame) sorry but I am feeling cross which is making my pulse race so i'll stop.

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