Safety of Atrovent® CFC-free inhaler: respiratory events reported from an observational cohort study in England

Int J Pharm Pract. 2018 Aug;26(4):356-363. doi: 10.1111/ijpp.12407. Epub 2017 Oct 9.


Objectives: The aim of the study was to identify any unexpected clinical events associated with starting the new CFC-free formulation of Atrovent® MDI in general practice in England.

Methods: An active surveillance cohort study was conducted with a focus on selected clinical events, including respiratory symptoms, in past users of Atrovent® CFC MDI ('switchers') and Atrovent® naïve users. Incidence density rate ratios (with 99% confidence intervals) for events occurring in the first 3 months of exposure (risk period-ID1-3 ) compared to 3 months prior to starting treatment (reference period-IDR ) were calculated.

Results: The cohort consisted of 13 211 patients (median age 70 years, 50.1% female; 63.5% prior users of Atrovent® CFC MDI ('switchers')). Common respiratory events occurred at higher rates after starting treatment than before for switchers, for example lower respiratory tract infection (LRTI) [ID1 /IDR = 1.45 (99% CI: 1.17, 1.81)] and worsening asthma [ID1 /IDR = 1.58 (99% CI: 1.00, 2.51)]. Of these events only LRTI was significant for Atrovent® naïve patients [ID1 /IDR = 1.42 (99% CI: 1.04, 1.95)].

Conclusions: The results of this study suggest effect modification of risk as a result of prior Atrovent® CFC MDI use. Overall, Atrovent® CFC-free MDI appeared to be reasonably well tolerated in the immediate postmarketing period and the safety profile appeared similar to that of the CFC formulation.

Keywords: Atrovent; CFC-free; cohort; respiratory; safety.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bronchodilator Agents / adverse effects*
  • Child
  • Cohort Studies
  • Disease Progression
  • Drug Substitution / adverse effects*
  • England / epidemiology
  • Female
  • Humans
  • Ipratropium / adverse effects*
  • Lung Diseases, Obstructive / drug therapy*
  • Male
  • Middle Aged
  • Nebulizers and Vaporizers
  • Product Surveillance, Postmarketing
  • Respiratory Tract Infections / epidemiology*
  • Respiratory Tract Infections / etiology
  • Young Adult


  • Bronchodilator Agents
  • Ipratropium