IACs linked to increased risk of acute urinary retention in men with COPD

Use of short- and long-acting inhaled anticholinergic (IAC) medications in men with chronic obstructive pulmonary disease (COPD) is associated with an increased risk of acute urinary retention (AUR), and men receiving concurrent treatment with both short- and long-acting IACs and those with evidence of benign prostatic hyperplasia are at highest risk, according to the results of a study published in the May 23 issue of Archives of Internal Medicine.

Anne Stephenson, MD, PhD, from St. Michael's Hospital, Toronto, Canada, and colleagues noted that systemic anticholinergic effects of IAC therapy have not been extensively studied. So, to determine the risk of AUR in seniors with COPD using IACs, they conducted a nested case-control study of individuals with COPD aged 66 years or older using population-based linked databases from Ontario, Canada. They searched the data for treatment with IACs and development of AUR between April 1, 2003 and March 31, 2009. Cases were identified as those who had been hospitalized, had same-day surgery, or an emergency department visit for AUR; these were matched with up to 5 control participants. Data was further segmented by patients' IAC regimens. The association between IAC use and AUR was analyzed with conditional logistic regression.

Among a cohort of 565,073 patients with COPD, 9,432 men and 1,806 women developed AUR. The relationship was statistically significant for men, but not for women. Men who had been using a regimen of IACs for 1 month or less were at increased risk (more than 40%) for AUR compared with nonusers (adjusted OR=1.42; 95% CI, 1.20–1.68). In men with evidence of benign prostatic hyperplasia, the risk was increased further (OR=1.81; 95% CI, 1.46–2.24). Combination use of both short- and long-acting IACs significantly increased risk of AUR compared with monotherapy users (OR=1.84; 95% CI, 1.25–2.71) or nonusers (OR=2.69; 95% CI, 1.93–3.76).

"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," the authors wrote. They added that the odds of AUR may be reduced by taking the lowest effective dose of IACs and avoiding combinations that raise a patient's risk. "Physicians and the public need to be aware of the potential for this significant adverse event so that preventive measures and potential therapy can be considered," they concluded.