Is there any association between inhaled ipratropium and mortality in patients with COPD and asthma?

Background: To determine whether ipratropium was associated with premature death inpatients with asthma and chronic obstructive pulmonary disease (COPD). Methods: A longitudinal cohort of 827 patients with COPD and 273 with asthma who were evaluated for compensation by two specialists in pulmonary medicine. Results: By June 1999, 538 of the patients with COPD and 77 of those with asthma had died. At the consultation, 77% of the COPD patients and 8.1% of the asthmatic patients were treated with inhaled ipratropium. Ipratropium was associated with mortality, risk ratio (RR) of 2.0 (95% confidence interval: 1.5-2.6) for COPD and 3.6 (1.8-71) for asthma patients. After adjustment for confounding factors [forced expiratory volume I s (FEV1), smoking habits, asthma medication, and presence of cor pulmonale] the RR for COPD was 1.6 (1.2-2.1) and for asthma 2.4 (1.2-5.0). Conclusions: The increased risk of premature death associated with ipratropium is of concern and necessitates further evaluation, e.g., in a randomised study. (C) 2002 Elsevier Science Ltd. All rights reserved.