Inhaled Anticholinergic Drug Therapy and the Risk of Acute Urinary Retention in Chronic Obstructive Pulmonary Disease

Stephenson, Anne L.; Seitz, Dallas; Bell, Chaim M.; Gruneir, Andrea; Gershon, Andrea S.; Austin, Peter C.; Fu, Longdi; Anderson, Geoffrey M.; Rochon, Paula A.; Gill, Sudeep S.

doi:10.1001/archinternmed.2011.170

Cited by 59 publications

(55 citation statements)

References 29 publications

(33 reference statements)

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“…The authors found (using multivariable conditional logistic regression) that new users of inhaled anticholinergics were significantly more likely to have sought medical care for acute urinary retention (OR 1.42; 95% CI 1.20-1.68) [Stephenson et al 2011]. However, as with Afonso's study above [Afonso et al 2011], the association of inhaled anticholinergics was less apparent when considering past users.…”

Section: Observational Studiesmentioning

confidence: 89%

Risk of acute urinary retention associated with inhaled anticholinergics in patients with chronic obstructive lung disease: systematic review

Loke

Singh

2013

Therapeutic Advances in Drug Safety

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BackgroundAcute urinary retention is a medical emergency which can be associated with serious complications. Previous studies have reported that the mortality rates in older men with precipitated acute urinary retention was double that of the general population [Armitage et al. 2007]. The mortality rates among men with acute urinary retention ranged from 9.5% in those aged between 45 and 54 years to 45.4% for men over 85 years of age [Armitage et al. 2007]. Hence, identification and avoidance of aetiological factors may have some impact in reducing risk of urinary retention and any associated medical complications.Acute urinary retention is typically related to the presence of prostatic disease. However, some drugs have been known to be associated with urinary retention, including antipsychotics, tricylic antidepressants, calcium channel antagonists and anticholinergic drugs [Verhamme et al. 2008].Risk of acute urinary retention associated with inhaled anticholinergics in patients with chronic obstructive lung disease: systematic review Yoon K. Loke and Sonal Singh Abstract: Inhaled anticholinergics (ipratropium bromide and tiotropium bromide) are widely used as maintenance treatment in chronic obstructive pulmonary disease. Previous studies have reported on their cardiovascular effects but relatively little is known about their effects on the bladder. Acute urinary retention is a medical emergency which can be associated with serious complications. Our objective was to evaluate the existing literature regarding the effects of inhaled anticholinergics on urinary retention among patients with chronic obstructive pulmonary disease. We searched PubMed and the United States Food and Drug Administration (FDA) adverse events database for case reports, observational studies, randomized controlled trials (or meta-analyses of such trials) that reported on the outcome of urinary retention with inhaled anticholinergics (ipratropium or tiotropium). We checked 27 published articles and identified relevant papers including two case reports, three pooled analyses, two observational studies and one randomized controlled trial. Two of the observational studies and a pooled analysis of randomized controlled trials reported a significant increase in the risk of acute urinary retention with inhaled anticholinergics. Older patients with benign prostatic hyperplasia seem to be at the highest risk of this adverse effect which tends to occur soon after treatment initiation. Although all the links in the chain have yet to be fully elucidated, the preponderance of evidence suggests the possibility of a causal relationship between inhaled anticholinergics and urinary retention. Clinicians should carefully balance these and other adverse effects of inhaled anticholinergics against their known symptomatic benefits on exacerbations, after eliciting patient preferences for various outcomes in a shared decisionmaking context.

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Section: Observational Studiesmentioning

confidence: 89%

Risk of acute urinary retention associated with inhaled anticholinergics in patients with chronic obstructive lung disease: systematic review

Loke

Singh

2013

Therapeutic Advances in Drug Safety

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“…While patients with severe COPD have a limited ability to sustain a bronchodilation, increasing blood flow to poorly ventilated lung regions causes a ventilation-perfusion mismatch. 21,22,24 Nebulized furosemide may reverse that pathological process by improving ventilation, particularly in patients who require higher doses of ␤ 2 -adrenoceptor agonists.…”

Section: Discussionmentioning

confidence: 99%

The Adjunctive Effect of Nebulized Furosemide in COPD Exacerbation: A Randomized Controlled Clinical Trial

Vahedi

Mahshidfar

Rabiee³

et al. 2013

Respir Care

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OBJECTIVE:To examine the effect of nebulized furosemide as an adjunct to the conventional treatment of patients with COPD exacerbation in an emergency department. METHODS: In this randomized double-blinded clinical trial, patients with COPD exacerbation were randomized to receive 40 mg nebulized furosemide or placebo as an adjunct to the conventional treatments. We recorded changes in dyspnea severity (measured with a visual analog scale), FEV 1 , arterial blood gas measurements, blood pressure, heart rate, and breathing frequency at baseline and 1 hour after treatment. RESULTS: We randomized 100 patients, whose mean age was 73.1 ؎ 8.7 y. The measured variables all improved significantly in both groups. FEV 1 , dyspnea, pH, mean blood pressure, and heart rate improved significantly more in the furosemide group. CONCLUSIONS: Nebulized furosemide benefits patients with COPD exacerbation.

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“…c o m / l o c a t e / l i f e s c i e aclidinium bromide at therapeutic doses in patients with COPD . The relatively high incidence of urinary difficulty and urinary retention reported for tiotropium in clinical practice (Kesten et al, 2006;Stephenson et al, 2011;Tashkin, 2009) prompted us to study the renal and urinary safety profile of aclidinium in preclinical animal models.…”

Section: Contents Lists Available At Sciverse Sciencedirectmentioning

confidence: 99%

“…Both drugs are considered to be relatively safe agents; however, they both have been associated with systemic anticholinergic side effects including dry mouth, constipation, blurred vision, glaucoma, urinary retention/difficulty and increased heart rate (Boehringer Ingelheim International GmbH, 2008a, 2008b. Recent studies have highlighted the risk of acute urinary retention (AUR) with current therapies in patients with COPD (Stephenson et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Aclidinium bromide, a novel long-acting muscarinic antagonist for COPD with improved preclinical renal and urinary safety profile

et al. 2012

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Inhaled Anticholinergic Drug Therapy and the Risk of Acute Urinary Retention in Chronic Obstructive Pulmonary Disease

Abstract: Use of short- and long-acting IACs is associated with an increased risk of AUR in men with COPD. Men receiving concurrent treatment with both short- and long-acting IACs and those with evidence of benign prostatic hyperplasia are at highest risk.

Cited by 59 publications

References 29 publications

Risk of acute urinary retention associated with inhaled anticholinergics in patients with chronic obstructive lung disease: systematic review

Risk of acute urinary retention associated with inhaled anticholinergics in patients with chronic obstructive lung disease: systematic review

The Adjunctive Effect of Nebulized Furosemide in COPD Exacerbation: A Randomized Controlled Clinical Trial

Aclidinium bromide, a novel long-acting muscarinic antagonist for COPD with improved preclinical renal and urinary safety profile

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