Inhaled anticholinergic drug therapy and the risk of acute urinary retention in chronic obstructive pulmonary disease: a population-based study.
Inhaled anticholinergic drug therapy and the risk of acute urinary retention in chronic obstructive pulmonary disease: a population-based study.
复制标题
吸入抗胆碱能药物治疗和慢性阻塞性肺疾病急性尿潴留的风险：一项基于人群的研究。
DOI：
10.1001/archinternmed.2011.170
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发表时间：
2011
影响因子：
--
通讯作者：
S. Gill
中科院分区：
文献类型：
--
作者：
A. Stephenson;D. Seitz;C. Bell;A. Gruneir;A. Gershon;P. Austin;L. Fu;G. Anderson;P. Rochon;S. Gill
背景
吸入抗胆碱能药物（IAC）广泛用于治疗慢性阻塞性肺病（COPD）。 IAC 治疗的全身抗胆碱能作用尚未得到广泛研究。本研究旨在利用 IAC 确定患有 COPD 的老年人发生急性尿潴留 (AUR) 的风险。
方法
2003 年 4 月 1 日至 2009 年 3 月 31 日期间，利用加拿大安大略省基于人群的链接数据库，对 66 岁或以上的慢性阻塞性肺病患者进行了一项巢式病例对照研究。住院、当天手术或急诊科就诊的 AUR 确诊病例，与最多 5 个对照相匹配。使用综合药物益处数据库确定 IAC 暴露量。进行条件逻辑回归分析以确定 IAC 使用与 AUR 之间的关联。
结果
在 565,073 名慢性阻塞性肺病患者中，有 9432 名男性和 1806 名女性患有 AUR。与未使用 IAC 的男性相比，刚刚开始 IAC 治疗方案的男性发生 AUR 的风险更高（调整后优势比 [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）。与单一疗法使用者（OR，1.84；95% CI，1.25-2.71）或非使用者（2.69；1.93-3.76）相比，同时使用短效和长效 IAC 的男性发生 AUR 的风险显着更高。
结论
使用短效和长效 IAC 与 COPD 男性 AUR 风险增加相关。同时接受短效和长效 IAC 治疗的男性以及有良性前列腺增生证据的男性风险最高。
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSIONS
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.