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Meta-Analysis
. 2006 Oct;21(10):1011-9.
doi: 10.1111/j.1525-1497.2006.00507.x.

Meta-analysis: anticholinergics, but not beta-agonists, reduce severe exacerbations and respiratory mortality in COPD

Shelley R Salpeter  1 , Nicholas S Buckley, Edwin E Salpeter
Affiliations
Meta-Analysis

Meta-analysis: anticholinergics, but not beta-agonists, reduce severe exacerbations and respiratory mortality in COPD

Shelley R Salpeter et al. J Gen Intern Med. 2006 Oct.

Erratum in

  • J Gen Intern Med. 2006 Oct;21(10):1131

Abstract

Background: Anticholinergics and beta2-agonists have generally been considered equivalent choices for bronchodilation in chronic obstructive pulmonary disease (COPD).

Objective: To assess the safety and efficacy of anticholinergics and beta2-agonists in COPD.

Design: We comprehensively searched electronic databases from 1966 to December 2005, clinical trial websites, and references from selected reviews. We included randomized controlled trials of at least 3 months duration that evaluated anticholinergic or beta2-agonist use compared with placebo or each other in patients with COPD.

Measurements: We evaluated the relative risk (RR) of exacerbations requiring withdrawal from the trial, severe exacerbations requiring hospitalization, and deaths attributed to a lower respiratory event.

Results: Pooled results from 22 trials with 15,276 participants found that anticholinergic use significantly reduced severe exacerbations (RR 0.67, confidence interval [CI] 0.53 to 0.86) and respiratory deaths (RR 0.27, CI 0.09 to 0.81) compared with placebo. Beta2-agonist use did not affect severe exacerbations (RR 1.08, CI 0.61 to 1.95) but resulted in a significantly increased rate of respiratory deaths (RR 2.47, CI 1.12 to 5.45) compared with placebo. There was a 2-fold increased risk for severe exacerbations associated with beta2-agonists compared with anticholinergics (RR 1.95, CI 1.39 to 2.93). The addition of beta2-agonist to anticholinergic use did not improve any clinical outcomes.

Conclusion: Inhaled anticholinergics significantly reduced severe exacerbations and respiratory deaths in patients with COPD, while beta2-agonists were associated with an increased risk for respiratory deaths. This suggests that anticholinergics should be the bronchodilator of choice in patients with COPD, and beta2-agonists may be associated with worsening of disease control.

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Figures

FIGURE 1
FIGURE 1
Flow chart of trials search.
FIGURE 2
FIGURE 2
Effect of anticholinergics compared with placebo on chronic obstructive pulmonary disease withdrawals, hospitalizations, and respiratory deaths (relative risk).
FIGURE 3
FIGURE 3
Effect of β2-agonists compared with placebo on chronic obstructive pulmonary disease withdrawals, hospitalizations, and respiratory deaths (relative risk).
FIGURE 4
FIGURE 4
Effect of β2-agonists compared with anticholinergics on chronic obstructive pulmonary disease withdrawals, hospitalizations, and respiratory deaths (relative risk).
See this image and copyright information in PMC

Comment in

References

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