Inhaler lung drugs tied to heart problems, deaths

Inhaler drugs used by millions of people with emphysema and bronchitis may slightly raise the risk for heart attacks and even death, a study suggests.

The results aren't conclusive and inhalers provide significant relief for these patients struggling to breathe. But the study authors urged doctors to closely monitor patients who use the inhalers.

Most affected patients have both emphysema and chronic bronchitis. The condition's formal name, chronic obstructive pulmonary disease, COPD, is the nation's fourth leading cause of death.

The study's increased risks were small, and the drugs' marketer said both medicines are safe. Outside experts called the study compelling but said it has limitations that make it hard to know if the drugs or something else was at fault.

The drugs are tiotropium, sold as Spiriva Handihaler by Boehringer Ingelheim Pharmaceuticals, Inc., and ipratropium, available generically and also sold by Boehringer under the brand name Atrovent.

Spiriva, approved in 2004, and the decade-old Atrovent are used once or more daily to relax muscles and open lung airways. They've been used by 8 million patients worldwide.

"We strongly disagree with the conclusion" in the new study, the manufacturers said in a statement.

COPD affects as many as 24 million Americans and kills more than 100,000 each year. It involves thickened and narrowed lung airways and excess mucous. Symptoms include persistent coughing and severe shortness of breath; smoking is a leading cause.

Patients describe COPD breathing problems as feeling like they're "living the entire day under water, unable to come to the surface," said Dr. Aaron Milstone of Vanderbilt University medical school.