Leonardo M. Fabbri, MD; Claus Vogelmeier, MD; Klaus F. Rabe, MD
Potential Conflicts of Interest: Dr. Fabbri has received consultancy fees from Actelion, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Elevation Pharmaceuticals, Merck Sharp & Dohme, Novartis, Nycomed, Pearl Therapeutics, Roche, and Sigma-Tau and payment for lectures and support for travel expenses from AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, EUROMEDIFORM, GlaxoSmithKline, German Centre for Lung Research, Merck Sharp & Dohme, Menarini, Mundipharma International, Novartis, Nycomed, TEVA Pharmaceuticals, Pfizer, and Sigma-Tau. His institution has received grants from Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Italian Ministry of Health, Italian Ministry for University and Research, Merck Sharp & Dohme, Nycomed, and Sigma-Tau. Dr. Vogelmeier has received consulting fees or honoraria and support for travel to meetings from Boehringer Ingelheim; is a board member for AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Mundipharma, Novartis, and Nycomed; and has received fees for expert testimony and grants from Talecris and payment for lectures or speaking from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Janssen-Cilag, Merck Sharp & Dohme, Novartis, Nycomed, and Talecris. Dr. Rabe has received consultancy fees and honoraria from, and is a board member for, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Merck Sharp & Dohme, Novartis, Nycomed, and Pfizer and has received grants from Altana, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Roche.
Fabbri L., Vogelmeier C., Rabe K.; Inhaled Long-Acting β-Agonists Versus Anticholinergics in Older Patients With Chronic Obstructive Pulmonary Disease. Ann Intern Med. 2011;155:561. doi: 10.7326/0003-4819-155-8-201110180-00018
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Published: Ann Intern Med. 2011;155(8):561.
TO THE EDITOR:
Gershon and colleagues (1) describe an increase in death and hospitalizations in patients aged 66 years or older with chronic obstructive pulmonary disease (COPD) who fill a first prescription for the long-acting anticholinergic tiotropium bromide compared with patients who do so for a long-acting β-agonist. These results were based on information from health administrative databases in Ontario, Canada, and contrast with the authors' previous findings (2).
Gershon and colleagues acknowledge the inherent limitations of this retrospective database analysis and conclude that “[f]urther research is needed to confirm these findings ... in a randomized, controlled trial.” We would like to note that this suggested “further research” has already been performed and published in the POET-COPD (Prevention of Exacerbations with Tiotropium in COPD) study (3), a randomized, controlled, double-blind trial that directly compared tiotropium bromide with the long-acting β-agonist salmeterol for 1 year.
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