TIA or stroke

[brons]

My 84 year old mother, has copd and is using advair, her doctor wants her to try spiriva and I am concerned about strokes. Is there a connection with either of these inhalers and strokes?

[National Jewish Health]

It has been reported that there is an increased risk of stroke, as an adverse side effect of Spiriva but the question remains unsettled.  One such report appeared in the Journal of the American Medical Association in September 2008.  The authors of this study found an increased risk of heart attacks and stroke (2.9% on the drug, Spiriva, compared to 1.8% of persons on placebo.  They interpreted this as, “a significantly increased risk.”  In March 2008, The FDA issued a statement that the manufacturer of spiriva had conducted an analysis of twenty nine clinical research studies that suggested a small excess risk of stroke (2 cases per 1000 persons using the drug.  They conducted a further study that indicated no increased risk.  More information  on a 4 year trial is expected this year.

The answer to your question is that there may or may not be an increased risk of heart attack or stroke with Spiriva but, if there is an increased risk, it is small.  Significant benefit from Spiriva has been demonstrated repeatedly.  This must be weighed against the potential increased risk of complications.

Good luck