Meta-analysis finds that common COPD drug increases deaths

That's not good:

A new analysis that compares two common inhalers for patients suffering from chronic obstructive pulmonary disease (COPD) finds that one reduces respiratory-related hospitalizations and respiratory deaths, but the other -- which is prescribed in the majority of cases -- increases respiratory deaths.

The Cornell and Stanford universities' statistical analysis of 22 trials with 15,276 participants found that common bronchodilators known as anticholinergics (generically named tiotropium and ipratropium) reduced severe respiratory events by 33 percent and respiratory-related deaths by 73 percent, compared with a placebo.

However, the same meta-analysis (which combines the results of the numerous studies) found that regularly inhaled beta-agonists (metaproterenol [Alupent], formoterol [Foradil], salmeterol [Serevent, Advair] and albuterol [Proventil, Ventolin, Volmax and others]) increased the risk of respiratory death more than twofold, compared with a placebo.

Yet only 5 percent of all prescriptions for COPD are anticholinergics, with beta-agonists dominating what doctors prescribe, the researchers report. (Emphasis mine.)

That is particularly not good because I remember learning a year ago before I took the medical boards that beta-agonists were the first line drug for COPD.

Actually, this is an example of something that happens fairly regularly in medical science. It is not always clear what the best drug for a condition is because the size of the study that is required to show the number of serious side-effects or deaths is sometimes very large. We think that we understand the mechanism for some drugs and we think that they will help, but often we don't understand them as well as we think we do. This is why hormone replacement for post-menopausal women was recommended for so long and eventually shown to do more harm than good.

It is important that studies like this get done though -- and that doctors are made aware of them as quickly as possible -- because they set what is called the Standard of Care. The Standard of Care is what a reasonable physician can be expected ethically -- and legally -- to prescribe. If we are failing to provide it, there should be consequences for our failure.

Unfortunately, the Standard of Care is not always as obvious as we would like.