Chronic obstructive pulmonary disease (COPD) is a lung disease in which the airways that carry air in and out of the lungs are partially obstructed, making it difficult to breathe. Patients with COPD often use inhaled anticholinergic drugs, such as ipratropium (marketed as Atrovent®, or combined with albuterol and marketed as Combivent®) and tiotropium (marketed as Spiriva®), to relax the muscles around their airways for easier breathing. These inhaled anticholinergic agents are associated with a significant increase in the risk of cardiovascular events, according to a study in the September 24, 2008 issue of the Journal of the American Medical Association.

Physicians from Wake Forest University School of Medicine and their colleagues performed a meta-analysis on 17 clinical trials of inhaled anticholinergic drugs. They found that, compared with COPD patients who took other inhaled agents or placebo inhalers containing no medication, COPD patients who used inhaled anticholinergic agents for at least one month had a 58% increased risk of cardiovascular death, heart attack, or stroke.

Cardiac death is the most common cause of death in patients with COPD, so this finding may be a significant public health issue. In light of this study, doctors and their COPD patients should weigh the potential risks and benefits of inhaled anticholinergics before starting these medications, especially for patients who already have other cardiovascular risk factors.