Inhaled Anticholinergics Linked to Acute Urinary Retention

Use of short- and long-acting inhaled anticholinergic medications (IACs) is associated with an increased risk for acute urinary retention (AUR) in men with chronic obstructive pulmonary disease (COPD), according to a new study.

Researchers at St. Michael's Hospital (Toronto, Canada) conducted a population-based, nested case-control study from April 1, 2003, to March 31, 2009, involving 565,073 individuals with COPD aged 66 years or older. A hospitalization, same-day surgery, or emergency department (ED) visit for AUR identified case subjects, which were matched with up to five controls each. 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.

The results showed that 9,432 men and 1,806 women developed AUR, and men who just initiated a regimen of IACs were at increased risk for AUR compared with nonusers. In men with evidence of benign prostatic hyperplasia (BPH), the risk was increased even further. Men using both short- and long-acting IACs had a significantly higher risk of AUR compared with monotherapy users or nonusers. The study was published in the May 23, 2011, issue of the Archives of Internal Medicine.

"Use of short- and long-acting IACs is associated with an increased risk of AUR in men with COPD," concluded lead author Anne Stephenson, MD, PhD, and colleagues. "Men receiving concurrent treatment with both short- and long-acting IACs and those with evidence of benign prostatic hyperplasia are at highest risk."

Anticholinergics are a class of medications that inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells. The nerve fibers of the parasympathetic system are responsible for the involuntary movements of smooth muscles present in the gastrointestinal tract, urinary tract, lungs, etc. IACs are therefore widely used for treatment of COPD, as they affect the muscles around the bronchi, stopping them from constricting.

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