[Pneumology. Should we fear inhaled anticholinergic bronchodilators?]

In 2008, studies on inhaled anticholinergic bronchodilators for chronic obstructive pulmonary disease (COPD) were published, some of them with contradictory messages. One study, and a meta-analysis suggested that inhaled ipratropium on the long- term is associated with increased risk for cardiac death. Therefore some caution should be at place when prescribing this drug in patients with coronary or rhythmic cardiac disease. On the other hand, a large randomized, placebo-controlled study on tiotropium did not suggested increased adverse cardio-vascular effects, but rather a diminution, and showed beneficial bronchodilator effect in patients with COPD. However the treatment did not attenuate the annual decline of lung function, and did not decrease mortality in these patients.