Men with COPD (chronic obstructive pulmonary disease) who take inhaled anticholinergic drugs have a higher chance of suffering from urinary retention, researchers from St. Michael’s Hospital, Toronto, Canada wrote in Archives of Internal Medicine.
The authors explain that approximately 10% of people aged 40+ years suffer from COPD, a progressive respiratory disorder in which the patients have problems breathing due to inflammation or blockage in the lungs.
IACs (inhaled anticholinergic drugs) make the smooth muscles in the airway relax by blocking stimulation from the cholinergic nerves – they reduce obstructions in airflow. However, nobody is sure whether they cause clinically important systemic anticholinergic effects.
Some clinical trials had linked IACs with acute urinary retention – a medical emergency in which the patient cannot urinate. Acute urinary retention has the risk of serious complications.
The authors wrote:
“Understanding the risk of AUR associated with IAC therapy would help to identify those at risk for this complication.”
Anne Stephenson, M.D., Ph.D. and team carried out a study within Ontario’s universal health insurance program. They gathered information on patients aged at least 66 years with COPD and sought out data on IAC therapy and the development of acute urinary retention between April 2003 and March 2009.
Out of 565,073 individuals with COPD, 1,806 females and 9,432 males developed acute urinary retention (AUR).
The authors wrote:
“This relationship was not statistically significant in women.”
As far as males were concerned, however, the relationship was significant. Males taking IACs for up to one month had a 40% higher chance of developing AUR, while those with an enlarged prostate on IACs had an 80% higher risk. Male patients who were taking both short and long acting IACs at the same time had a considerably higher risk of developing AUR.
The authors explained:
“Physicians should highlight for patients the possible connection between urinary symptoms and inhaled respiratory medication use to ensure that changes in urinary flow (ie, incomplete voiding, urinary incontinence, and decreased urinary flow) are reported to the physician prescribing the IAC.”
AUR risk is lower if patients take the lowest dose possible and avoid combinations that may increase risk.
The authors concluded:
“Physicians and the public need to be aware of the potential for this significant adverse event,” they conclude, “so that preventive measures and potential therapy can be considered.”
Anne Stephenson, MD, PhD; Dallas Seitz, MD; Chaim M. Bell, MD, PhD; Andrea Gruneir, PhD; Andrea S. Gershon, MD, MSc; Peter C. Austin, PhD; Longdi Fu, MSc; Geoffrey M. Anderson, MD, PhD; Paula A. Rochon, MD, MPH; Sudeep S. Gill, MD
Arch Intern Med. 2011;171(10):920-922.
Written by Christian Nordqvist