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Original Research: COPD |

Bronchodilator Use and the Risk of Arrhythmia in COPDBronchodilators and Arrhythmia Risk: Part 1: Part 1: Saskatchewan Cohort Study

Machelle Wilchesky, PhD; Pierre Ernst, MD; James M. Brophy, MD, PhD; Robert W. Platt, PhD; Samy Suissa, PhD
Author and Funding Information

From the Donald Berman Maimonides Geriatric Centre (Dr Wilchesky), the Department of Medicine (Drs Ernst, Brophy, and Suissa), the Department of Epidemiology, Biostatistics and Occupational Health (Drs Brophy, Platt, and Suissa), the Division of Clinical Epidemiology, McGill University Health Centre (Dr Brophy), and the Department of Pediatrics (Dr Platt), McGill University; and the Centre for Clinical Epidemiology (Drs Wilchesky, Ernst, and Suissa), Jewish General Hospital-Lady Davis Research Institute, Montreal, QC, Canada.

Correspondence to: Samy Suissa PhD, Centre for Clinical Epidemiology, Jewish General Hospital-Lady Davis Research Institute, 3755 Côte Ste-Catherine, H-461, Montreal, QC H3T 1E2, Canada; e-mail: samy.suissa@mcgill.ca


For editorial comment see page 271

For related article see page 305

Funding/Support: This study was funded by a grant from the Canadian Institutes for Health Research (CIHR) and from the Canadian Foundation for Innovation (CFI) that permitted data acquisition. Dr Wilchesky was the recipient of a CIHR Doctoral Research Award. Dr Suissa is the recipient of the James McGill Professorship award. Drs Brophy and Platt are Research Scholars of le Fonds de Recherche en Santé du Québec.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(2):298-304. doi:10.1378/chest.10-2499
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Background:  Bronchodilators are first-line therapy for COPD. There is some evidence that they may increase the risk of cardiac arrhythmias.

Methods:  We used the computerized health-care databases of the Province of Saskatchewan, Canada, to identify a cohort of subjects with COPD, aged ≥ 55 years, between 1990 and 1999. The subjects were followed until December 2003 for a hospital admission for, or death from, arrhythmia. A nested case-control approach was used to match each arrhythmia case on age, sex, and calendar time to 20 control subjects selected from the corresponding cohort risk set. Conditional logistic regression was used to estimate the rate ratio (RR) of arrhythmia associated with new use of bronchodilators, adjusted for disease severity and comorbidity.

Results:  The cohort included 6,018 patients with COPD in whom 469 arrhythmia cases occurred, including 56 deaths, for an overall rate of 1.37 arrhythmias per 100 per year. The rate of arrhythmia was elevated with the new use of ipratropium (RR, 2.4; 95% CI, 1.4-4.0) and of long-acting β-agonists (LABAs) (RR, 4.5; 95% CI, 1.4-14.4). It was not elevated with new use of short-acting β-agonists (RR, 0.9; 95% CI, 0.5-1.6) or methylxanthines (RR, 1.6; 95% CI, 0.7-3.7).

Conclusions:  The new use of bronchodilators, particularly ipratropium and LABAs, may increase the risk of cardiac arrhythmias in patients with COPD. Although these results raise concerns regarding LABAs, they were based on few cases and require confirmation in larger cohorts.

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