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Q How effective are anticholinergics and β2 agonists for chronic obstructive pulmonary disease (COPD)?
Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★★☆ Respirology ★★★★★★☆
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 β2 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.
exacerbations causing withdrawal from the study, severe exacerbations requiring hospital admission, and respiratory death.
Anticholinergics used were ipratropium and tiotropium. β2 agonists used …
For correspondence: Dr S R Salpeter, Stanford University School of Medicine, Stanford, CA, USA.
Source of funding: no external funding.