Is there any association between inhaled ipratropium and mortality in patients with COPD and asthma?

Respir Med. 2003 Mar;97(3):264-72. doi: 10.1053/rmed.2003.1423.


Background: To determine whether ipratropium was associated with premature death in patients with asthma and chronic obstructive pulmonary disease (COPD).

Methods: A longitudinal cohort of 827 patients with COPD and 273 with asthma who were evaluated for compensation by two specialists in pulmonary medicine.

Results: By June 1999, 538 of the patients with COPD and 77 of those with asthma had died. Atthe consultation, 77% ofthe COPD patients and 8.1% of the asthmatic patients were treated with inhaled ipratropium. Ipratropium was associated with mortality risk ratio (RR) of 2.0 (95% confidence interval: 1.5-2.6) for COPD and 3.6 (1.8-7.1) for asthma patients. After adjustment for confounding factors [forced expiratory volume 1 s (FEV1), smoking habits, asthma medication, and presence of cor pulmonale] the RR for COPD was 1.6 (1.2-2.1) and for asthma 24 (1.2-5.0).

Conclusions: The increased risk of premature death associated with ipratropium is of concern and necessitates further evaluation, e.g., in a randomised study.

MeSH terms

  • Administration, Inhalation
  • Asthma / drug therapy*
  • Asthma / mortality
  • Body Mass Index
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / adverse effects*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume / drug effects
  • Humans
  • Ipratropium / administration & dosage
  • Ipratropium / adverse effects*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Pulmonary Disease, Chronic Obstructive / mortality*
  • Survival Analysis
  • Survival Rate
  • Vital Capacity / drug effects


  • Bronchodilator Agents
  • Ipratropium