The use of inhaled anticholinergics in chronic obstructive pulmonary disease: is there cause for concern? A review of evidence from clinical trials

Chronic obstructive pulmonary disease (COPD) is a common condition affecting men and women equally that worsens quality of life and increases mortality. The burden of illness from COPD is rising rapidly and is now recognized as a global health issue. Diagnosis and management guidelines have been developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD defines disease severity according to airflow limitation and guides pharmacological therapy in a step‑wise fashion. Inhaled bronchodilators – i.e., β2‑agonists and anticholinergics – are the therapeutic mainstay for patients with COPD. Current guidelines recommend that all symptomatic patients with COPD should be prescribed a short‑acting bronchodilator to be used on an as‑needed basis. If symptoms are inadequately controlled, a long‑acting bronchodilator should be added and used regularly. Furthermore, GOLD and many other guideline groups recommend inhaled anticholinergics as one of the first‑line agents for the long‑term therapy of COPD patients. However, recent controversy has erupted around anticholinergics’ cardiovascular safety, based on newly published data from analyses looking at older studies suggesting harm and 1 large recent trial confirming safety. This provides the facts surrounding this debate and reinforces our belief in the safety of inhaled anticholinergics.