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    Inhaled Drugs for COPD Linked to Urinary Problem

    Study Shows Inhaled Anticholinergic Drugs May Increase Risk for Acute Urinary Retention

    Industry Perspective

    Companies that manufacture anticholinergic inhalers say the risk of urinary retention associated with anticholinergic drugs is known.

    "It does not add clinical information that would at all change the risk-benefit profile of Spiriva," says Emily Baier, a spokeswoman for Boehringer Ingelheim, the company that makes Spiriva.

    "Urinary retention is a known side effect of anticholinergics and can occur in particular with patients with conditions like BPH [benign prostatic hypertrophy]. This is actually listed in our label," Baier says.

    Urinary Retention in COPD Patients

    Using a database of more than 565,000 Canadians over age 65 with COPD, researchers identified more nearly 10,000 men and 2,000 women who had at least one episode of acute urinary retention in a six-year period between 2003 and 2009.

    People were excluded from the analysis if they'd had radical cystectomy, or surgery to remove the bladder, or if they had a history of acute urinary retention, since having one episode increases the chances for another.

    Each person with acute urinary retention was compared to five other people of the same age who had not experienced a problem with urination.

    No increased risk was seen in women.

    Among men, however, those who were new users, meaning that they had started treatment in the last 30 days, had a 42% increased risk of acute urinary retention compared to those not taking the drugs.

    Men who had been on the medications for longer than 30 days had a 36% increased risk of acute urinary retention, while past users of the medications did not have a significantly different risk compared to nonusers.

    Men with enlarged prostates who were new users of inhaled anticholinergic drugs had an even greater risk, about 80%, compared to those not taking the medications.

    To express the risk a different way, researchers calculated that 514 men with COPD and enlarged prostates would need to take these kinds of inhaled bronchodilators for one man to experience acute urinary retention within 30 days of starting the medication.

    After six months of treatment, however, that number drops to one in 263 men.

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