Comments from 00doc et al. on the following report would be
appreciated.
MikeV

Newstarget.com

(Originally published September 5 2006)

A new analysis that compares two common inhalers for patients
suffering from chronic obstructive pulmonary disease (COPD) finds
that one reduces respiratory-related hospitalizations and
respiratory deaths, but the other -- which is prescribed in the
majority of cases -- increases respiratory deaths.
The Cornell and Stanford universities' statistical analysis of 22
trials with 15,276 participants found that common bronchodilators
known as anticholinergics (generically named tiotropium and
ipratropium) reduced severe respiratory events by 33 percent and
respiratory-related deaths by 73 percent, compared with a placebo.

However, the same meta-analysis (which combines the results of the
numerous studies) found that regularly inhaled beta-agonists
(metaproterenol [Alupent], formoterol [Foradil], salmeterol
[Serevent, Advair] and albuterol [Proventil, Ventolin, Volmax and
others]) increased the risk of respiratory death more than twofold,
compared with a placebo.

Yet only 5 percent of all prescriptions for COPD are
anticholinergics, with beta-agonists dominating what doctors
prescribe, the researchers report.

The study, now online, will be published in an upcoming issue of the
Journal of General Internal Medicine.

COPD is a progressive lung disease characterized by difficulty
breathing, wheezing and a chronic cough. Complications include
bronchitis and pneumonia. It is often associated with smoking.

"When patients used the anticholinergics, they experienced fewer
severe exacerbations requiring hospitalizations and fewer
respiratory deaths than those taking only a placebo," said Edwin
Salpeter, the J.G. White Distinguished Professor of Physical
Sciences Emeritus at Cornell, who led the statistical analysis in
the study. An eminent astrophysicist, Salpeter has more recently
focused his attention on medical statistics. "With the
beta-agonists, it's the other way around, where the number of
respiratory deaths increased when compared with those who took only
the placebo."

"These results suggest that anticholinergics should be the
bronchodilator of choice in COPD," said Shelley Salpeter, M.D.,
Edwin Salpeter's daughter and the lead author. She is a clinical
professor of medicine at Stanford's School of Medicine and a
physician at Santa Clara Valley Medical Center in San Jose, Calif.
"The long-term safety of beta-agonists in patients with COPD should
be addressed."

A recent meta-analysis by the Salpeters also revealed that
beta-agonist inhalers increased both hospitalizations and deaths in
asthma sufferers of all ages.

Previous studies have shown that patients with COPD build up
tolerance to beta-agonists' bronchodilator and bronchoprotective
effects after regular treatment compared with the first dose.

While beta-agonists may reduce symptoms through bronchodilation, the
researchers believe they also promote bronchial inflammation and
sensitivity by reducing bronchial protection without any warning of
increased symptoms, which can then lead to a life-threatening
response.

In the trials that were analyzed, only two patients out of 4,036 who
took anticholinergics died of respiratory causes, while 12 of 3,845
participants in the placebo group died of respiratory ailments. When
patients inhaled beta-agonists, there were 21 respiratory deaths out
of 1,320 patients and eight respiratory deaths out of 1,084
participants in the placebo group.

Contact: Krishna Ramanujan ksr32@cornell.edu 607-255-3290 Cornell
University News Service