Higher Risk of Acute Urinary Retention with Inhaled Anticholinergics for Chronic Obstructive Pulmonary Disease

For men with chronic obstructive pulmonary disease (COPD), inhaled anticholinergic therapy may lead to an increased risk of acute urinary retention, suggests a study in the Archives of Internal Medicine.

The nested case–control study included 9432 male and 1806 female patients with COPD who were treated for acute urinary retention between 2003 and 2009. The patients, aged 60 years or older, were identified from Ontario health databases. Each case patient was matched with up to five control individuals. Associations with inhaled anticholinergic use, based on prescription records, were assessed.

Compared with control individuals, patients with acute urinary retention had higher rates of prostate disease, neurologic disease, and urinary incontinence. Among men, those who had recently started inhaled anticholinergic therapy were at increased risk of acute urinary retention: 42 percent higher on adjusted analysis. For anticholinergic-exposed men with evidence of benign prostatic hyperplasia, the increase in risk was 81 percent. The risk of acute urinary retention was increased for men who used either short- or long-acting inhaled anticholinergics. For women with COPD, anticholinergic use was not significantly associated with acute urinary retention.

The population-based study adds to recent evidence suggesting an increased risk of acute urinary retention in men with COPD taking inhaled anticholinergics. Patients treated with both short- and long-acting inhaled anticholinergics and those with benign prostatic hyperplasia appear to be at highest risk. Patients with COPD and their physicians should be aware of this association and the possible preventive and treatment interventions [Stephenson A, et al. Inhaled anticholinergic drug therapy and the risk of acute urinary retention in chronic obstructive pulmonary disease: a population-based study. Arch Intern Med 2011; 171:914–920].

August 2011 (Vol. 3, Number 8)