Page last updated at 07:58 GMT, Wednesday, 24 September 2008 08:58 UK
Inhalers prescribed for serious lung disease may increase the risk of deadly
heart problems, say researchers.
Trials on more than 15,000 patients found inhaled anticholinergic drugs
increased the risk of heart attack, stroke and cardiovascular death by 58%.
The drugs, Atrovent and Spriva, open up the airways to help patients with
chronic obstructive pulmonary disease (COPD) to breathe.
The work is published in the Journal of the American Medical Association.
More than two million prescriptions for anticholinergic inhalers were issued
in England last year, according to the researchers from the Wake Forest
University School of Medicine in the US and the University of East Anglia in the
In the 17 trials that they analysed, long-term use (more than 30 days) of the
two anticholinergics ipratropium (Atrovent) and tiotropium (Spiriva) increased
the risk of a heart attack by 53% and the risk of cardiovascular death by 80%.
This would mean the drugs could cause one in 40 users to die from a heart
condition and one in 174 to have a heart attack, say the researchers.
Risks versus benefits
But they said these risks had to be balanced against the benefits of using an
inhaler – they improve patients’ quality of life by preventing disease
exacerbations and COPD-related hospitalisations.
Researcher Dr Yoon Loke said: “It is a relatively small risk – about 3% of
users develop problems – but the risk is serious. They may cause heart attacks
“There are alternatives. If you know that your inhaler contains
anticholinergics, my advice would be to ask your doctor to prescribe a different
inhaler, particularly if you have a history of heart trouble or are at high risk
of heart disease.”
He said the vast majority of people with COPD are or have been heavy smokers,
so they are already at heightened risk of heart attacks.
The current study was unable to determine if these risk factors influenced the
Dr Loke’s team started to look at the problem after the manufacturers issued a
warning earlier this year through the US Food and Drug Administration that there
could be a higher risk of stroke as a result of using these inhalers.
Boehringer Ingelheim said it strongly disagreed with Dr Loke’s findings. Its
latest analysis of 30 placebo-controlled double-blind, randomised trials with
data from 19,545 COPD patients “demonstrated that there is no increased risk of
death (all-cause) or death due to cardiovascular events” in patients treated
Dr Keith Prowse, chairman of the British Lung Foundation, said:
“Anticholinergic agents are a very useful and important medication for a large
number of people with COPD.
“This study highlights a possible risk of heart attack associated with the
medication but the authors acknowledge that there is insufficient data to allow
full analysis of other risk factors, including hypertension and pre-existing
heart disease, so we need more research to establish accurate levels of risk.
“In the meantime, people should discuss any concerns they have with their GP.”
Judy O’Sullivan, cardiac nurse at the British Heart Foundation, said: “Anyone
with COPD who is benefitting from taking anticholinergic inhalers should not
stop taking them based on this study alone.”
COPD caused over 27,000 deaths in the UK in 2004, and is projected to be the
world’s fifth biggest killer by 2020.
Elaine Vickers, research manager at Asthma UK, said: “This research looks
solely at people with COPD who, unlike most people with asthma, have
irreversible damage to their airways.
“This study looks specifically at medicines not commonly used to treat asthma
and if you have asthma it is vital that you take your medicines as prescribed.
“If you have any concerns please speak with your doctor or asthma nurse or
call the Asthma UK Adviceline on 08457 01 02 03.”