Therapeutics
Review: anticholinergics but not ß2 agonists reduce exacerbations requiring hospital admission and respiratory deaths in COPD
Salpeter SR, Buckley NS, Salpeter EE. Meta-analysis: anticholinergics, but not beta-agonists, reduce severe exacerbations and respiratory mortality in COPD. J Gen Intern Med 2006;21:1011–9.[CrossRef][Medline]
Q How effective are anticholinergics and ß2 agonists for chronic obstructive pulmonary disease (COPD)?
IM/Ambulatory care Respirology
Key Words: adrenergic beta-agonists • albuterol • bronchodilator agents • ethanolamines • lung diseases (obstructive)
| The first 150 words of the full text of this article appear below. |
Data sources:
Medline, EMBASE/Excerpta Medica, and Cochrane databases (to December 2005); US Food and Drug Administration website; and references of identified reviews.
Study selection and assessment:
randomised controlled trials (RCTs) in any language that compared anticholinergics or ß2 agonists with placebo or with each other; had 
3 month follow up; and reported COPD exacerbations requiring study withdrawal or hospital admission, or respiratory death. 22 RCTs (n = 15 276, mean age range 60–64 y) with mean 20 month follow up (range 3–60 mo) met the selection criteria. Methodological quality of individual studies was based on randomisation procedure and allocation concealment, blinding of patients and providers, reporting of withdrawals and dropouts, and intention to treat analysis.
Outcomes:
exacerbations causing withdrawal from the study, severe exacerbations requiring hospital admission, and respiratory death.
Anticholinergics used were ipratropium and tiotropium. ß2 agonists used were albuterol, metaproterenol, formoterol, and salmeterol. Compared with placebo, anticholinergics reduced
University of Miami, Miller School of Medicine,
Miami, Florida, USA
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