Stephenson Anne, Seitz Dallas, Bell Chaim M, Gruneir Andrea, Gershon Andrea S, Austin Peter C, Fu Longdi, Anderson Geoffrey M, Rochon Paula A, Gill Sudeep S
Department of Medicine, Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.
Arch Intern Med. 2011 May 23;171(10):914-20. doi: 10.1001/archinternmed.2011.170.
Inhaled anticholinergic medications (IACs) are widely used treatments for chronic obstructive pulmonary disease (COPD). The systemic anticholinergic effects of IAC therapy have not been extensively studied. This study sought to determine the risk of acute urinary retention (AUR) in seniors with COPD using IACs.
A nested case-control study of individuals with COPD aged 66 years or older was conducted from April 1, 2003, to March 31, 2009, using population-based linked databases from Ontario, Canada. A hospitalization, same-day surgery, or emergency department visit for AUR identified cases, which were matched with up to 5 controls. Exposure to IACs was determined using a comprehensive drug benefits database. Conditional logistic regression analysis was conducted to determine the association between IAC use and AUR.
Of 565,073 individuals with COPD, 9432 men and 1806 women developed AUR. Men who just initiated a regimen of IACs were at increased risk for AUR compared with nonusers (adjusted odds ratio [OR], 1.42; 95% confidence interval [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). Men using both short- and long-acting IACs had a significantly higher risk of AUR compared with monotherapy users (OR, 1.84; 95% CI, 1.25-2.71) or nonusers (2.69; 1.93-3.76).
Use of short- and long-acting IACs is associated with an increased risk of AUR in men with COPD. Men receiving concurrent treatment with both short- and long-acting IACs and those with evidence of benign prostatic hyperplasia are at highest risk.
吸入性抗胆碱能药物（IACs）是慢性阻塞性肺疾病（COPD）广泛使用的治疗药物。IAC治疗的全身抗胆碱能作用尚未得到广泛研究。本研究旨在确定使用IACs的COPD老年患者发生急性尿潴留（AUR）的风险。
2003年4月1日至2009年3月31日，利用加拿大安大略省基于人群的关联数据库，对66岁及以上的COPD患者进行了一项巢式病例对照研究。因AUR住院、当日手术或急诊就诊确定为病例，病例与最多5名对照进行匹配。使用综合药物效益数据库确定IACs暴露情况。进行条件逻辑回归分析以确定IAC使用与AUR之间的关联。
在565,073名COPD患者中，9432名男性和1806名女性发生了AUR。与未使用者相比，刚开始使用IACs方案的男性发生AUR的风险增加（调整优势比[OR]，1.42；95%置信区间[CI]，1.20 - 1.68）。在有良性前列腺增生证据的男性中，风险进一步增加（OR，1.81；95%CI，1.46 - 2.24）。与单药使用者（OR，1.84；95%CI，1.25 - 2.71）或未使用者（2.69；1.93 - 3.76）相比，但使用长效和短效IACs的男性发生AUR的风险显著更高。
使用长效和短效IACs与COPD男性患者发生AUR的风险增加相关。同时接受长效和短效IACs治疗的男性以及有良性前列腺增生证据的男性风险最高。
