How safe are anticholinergics in patients with COPD?

more prevalent in the anticholinergic group, with a relative risk of 1.60 (95% CI, 1.22–2.10) and a risk difference of 0.007 (95% CI, 0.003–0.013). The secondary outcome was all-cause mortality, which was not statistically different between the two groups (the revised value given in the correction to the original study [P =0 .05] approaches, but does not reach, statistical significance). The nested case–control study by Lee et al used national databases to identify 32 130 cases (patients with COPD who died) and 10 times that number of controls (surviving patients with COPD) in the US. 5 It showed an association of ipratropium use with both all-cause mortality (odds ratio [OR], 1.11; 95% CI, 1.08–1.15) and cardiovascular death (OR, 1.34; 95% CI, 1.22– 1.47). Tiotropium was not examined in this study. Coincidentally, results of the largest and longest-running randomised controlled trial of tiotropium use — the UPLIFT trial — have also recently been published. 8 This was a 4-year study