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Original Research |

Bronchodilator Use and the Risk of Arrhythmia in COPDBronchodilators and Arrhythmia Risk in COPD Part 2-: Part 2: Reassessment in the Larger Quebec Cohort

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), 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, Montréal, QC, H3T 1E2, Canada; e-mail: samy.suissa@mcgill.ca


For editorial comment see page 271

For related article see page 298

Funding/Support: This study was funded by the Canadian Institutes for Health Research (CIHR) [Grant 94480]. 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):305-311. doi:10.1378/chest.11-1597
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Background:  A previous study suggested a potential increased risk of cardiac arrhythmia with new use of long-acting β-agonists and ipratropium bromide in patients with COPD, although conclusions were limited by the small cohort size.

Methods:  We reassessed this association in a larger cohort formed from the health-care databases of the province of Quebec, Canada. We identified a cohort of patients with COPD aged ≥ 67 years who began treatment between 1990 and 1999 and followed them until December 2003. A nested case-control approach matched each subject who developed severe arrhythmia during follow-up with 20 control subjects from the cohort on age, sex, and calendar time. The rate ratio (RR) of arrhythmia associated with new use of bronchodilators was estimated using conditional logistic regression, adjusting for COPD disease severity, cardiovascular disease, and other comorbidities.

Results:  The cohort included 76,661 patients with COPD, of whom 5,307 developed an arrhythmia (10.3 arrhythmias per 1,000 per year), 621 of which were fatal. The rate of cardiac arrhythmias was elevated with the new use of short-acting (RR, 1.27; 95% CI, 1.03-1.57) and long-acting (RR, 1.47; 95% CI, 1.01-2.15) β-agonists. The rate was slightly elevated, although not statistically significantly, with new use of ipratropium bromide (RR, 1.23; 95% CI, 0.95-1.57) and methylxanthines (RR, 1.28; 95% CI, 0.93-1.77). These effects waned with longer-term use.

Conclusions:  New use of short- and long-acting β-agonists may slightly increase the risk of cardiac arrhythmia in patients with COPD. It remains unclear whether ipratropium bromide also increases this risk, despite the use of a larger study population.


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