Letters: No reason to stop scrips for anticholinergics

GP reports a study by Singh (JAMA 2008; 300: 1,439-50) on anticholinergic inhalers and CVD risk (GP, 26 September).

The study found no causal link between anticholinergic inhalers and CVD, but an association. The justification for the study came from the finding of a previous meta-analysis reported by the FDA which found that tiotropium was associated with an increased risk of stroke.

No association was found with stroke in the new study by Singh et al but, instead, a different set of associations was reported.

In our view, the Singh study has several methodological problems including double counting patients, comparing tiotropium to both active treatments and placebos and failing to account for increased drop-outs in the placebo arms as this resulted in a smaller risk of adverse events.

The findings of an increased risk of cardiovascular events are interesting, and merit further consideration, but are not a reason to change prescribing. The results of the UPLIFT study to be released this month may clarify the safety profile of tiotropium.

We believe Dr Yoon's comments in your article are completely inappropriate. GPs should not change the way they prescribe anticholinergic inhalers on the basis of this single study unless advised by independent bodies. There is no clinical rationale to prescribe anticholinergics for short-term use - they are to treat symptoms and prevent exacerbations of a long-term progressive condition.

Long-term benefits of anticholinergic inhalers have been demonstrated and are reported in UK national and all international guidelines. Dr Yoon's recommendations to GPs on the basis of his single study will cause unnecessary distress to patients and confusion to clinicians.

GPs should allow time for the findings to be considered in the light of other scientific data and reach a calm objective conclusion before they change their prescribing habits.

Professor David Price, professor of primary care respiratory medicine, Aberdeen University; Dr Rupert Jones, GP in Plymouth; Dr Dermot Ryan, GP in Loughborough; Dr Mike Thomas, GP in Gloucestershire; Dr Daryl Freeman, GP in Norfolk; Dr John Haughney, GP in Scotland.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

NHS Employers updates guidance for assessing COVID-19 risk in BAME staff

NHS Employers updates guidance for assessing COVID-19 risk in BAME staff

Updated guidance to help GP practices assess and mitigate the risk staff from black,...

PHE unable to confirm it will meet deadline for COVID-19 risk report

PHE unable to confirm it will meet deadline for COVID-19 risk report

Public Health England (PHE) has been unable to confirm if its report into how factors...

More than half of GP locums have seen a significant drop in income due to COVID-19

More than half of GP locums have seen a significant drop in income due to COVID-19

More than half of GP locums have experienced a significant fall in their income during...

How a GP helped develop a protective shield to cover patients needing CPR in the pandemic

How a GP helped develop a protective shield to cover patients needing CPR in the pandemic

Wiltshire GP Dr Lydia Campbell-Hill explains how she helped create a mini isolation...

GP practices can now sign up to new online PPE portal

GP practices can now sign up to new online PPE portal

GP practices will be able to register with the DHSC's new online PPE portal, which...

Fully-qualified GP workforce fell by 712 over the past year

Fully-qualified GP workforce fell by 712 over the past year

The fully-qualified GP workforce in England fell by 2.5%, losing 712 full-time equivalent...