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Urinary Incontinence in Chronic Obstructive Pulmonary Disease: A Common Co-morbidity or a Typical Adverse Effect?

Abstract

Urinary incontinence (UI) is defined as a loss of bladder control and is characterized by the complaint of any involuntary leakage of urine. Evidence suggests that the prevalence of UI is higher in subjects with chronic obstructive pulmonary disease (COPD) than in age-matched controls in both sexes. UI is classified as stress, urge, and mixed, and has a considerable impact on quality of life. However, the prevalence of UI in individuals with COPD is mostly unexplored in clinical research and often underestimated in clinical practice. Interestingly, although the involuntary leakage of a small amount of urine during coughing (e.g., stress UI) is among the most plausible causes of UI in patients with COPD, its importance has been questioned by some researchers. Moreover, UI as a respiratory drug-related adverse effect is largely overlooked; only a few randomized controlled trials have reported the presence of urinary symptoms, mainly as urinary retention due to anticholinergic agents. In this narrative review, we explored whether, and to what extent, UI occurs in COPD individuals, and what the proposed actions to improve this condition are. We found that the association between UI and COPD is largely unexplored, mostly because UI tends to be attributed to older age. We infer that the prevalence of UI in individuals with chronic respiratory symptoms is often underestimated in clinical practice. The misinterpretation of urinary symptoms as related to the respiratory condition can delay diagnostic and therapeutic approaches. The use of simple self-administered questionnaires to assess the presence of UI is encouraged.

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References

  1. 1.

    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Standardisation Sub-Committee of the International Continence Society, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61:37–49.

    Article  PubMed  Google Scholar 

  2. 2.

    Putcha N, Puhan MA, Hansel NN, Drummond MB, Boyd CM. Impact of co-morbidities on self-rated health in self-reported COPD: an analysis of NHANES 2001–2008. COPD. 2013;10:324–32.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Hrisanfow E, Hagglund D. The prevalence of urinary incontinence among women and men with chronic obstructive pulmonary disease in Sweden. J Clin Nurs. 2011;20:1895–905.

    Article  PubMed  Google Scholar 

  4. 4.

    Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2019. http://www.goldcopd.org/. Accessed Feb 2019.

  5. 5.

    Schnell K, Weiss CO, Lee T, Krishnan JA, Leff B, Wolff JL, et al. The prevalence of clinically-relevant comorbid conditions in patients with physician-diagnosed COPD: a cross-sectional study using data from NHANES 1999–2008. BMC Pulm Med. 2012;12:26.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Hirayama F, Lee AH, Binns CW, Nishimura K, Taniguchi H. Association of impaired respiratory function with urinary incontinence. Respirology. 2009;14:753–6.

    Article  PubMed  Google Scholar 

  7. 7.

    Hirayama F, Lee AH, Binns CW, Taniguchi H, Nishimura K, Kato K. Urinary incontinence in men with chronic obstructive pulmonary disease. Int J Urol. 2008;15:751–3.

    Article  PubMed  Google Scholar 

  8. 8.

    Button BM, Holland AE, Sherburn MS, Chase J, Wilson JW, Burge AT. Prevalence, impact and specialised treatment of urinary incontinence in women with chronic lung disease. Physiotherapy. 2019;105:114–9.

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Burge AT, Lee AL, Kein C, Button BM, Sherburn MS, Miller B, et al. Prevalence and impact of urinary incontinence in men with chronic obstructive pulmonary disease: a questionnaire survey. Physiotherapy. 2017;103:53–8.

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Vanfleteren LE, Spruit MA, Groenen M, Gaffron S, van Empel VP, Bruijnzeel PL, et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187:728–35.

    Article  PubMed  Google Scholar 

  11. 11.

    Maggi S, Minicuci N, Langlois J, Pavan M, Enzi G, Crepaldi G. Prevalence rate of urinary incontinence in community-dwelling elderly individuals: the Veneto study. J Gerontol A Biol Sci Med Sci. 2001;56:M14–8.

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Jackson RA, Vittinghoff E, Kanaya AM, Miles TP, Resnick HE, Kritchevsky SB, et al. Urinary incontinence in elderly women: findings from the health, aging, and body composition study. Obstet Gynecol. 2004;104:301–7.

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Madill SJ, Harvey MA, McLean L. Women with stress urinary incontinence demonstrate motor control differences during coughing. J Electromyogr Kinesiol. 2010;20:804–12.

    Article  PubMed  Google Scholar 

  14. 14.

    Chung E, Katz DJ, Love C. Adult male stress and urge urinary incontinence—a review of pathophysiology and treatment strategies for voiding dysfunction in men. Aust Fam Phys. 2017;46:661–6.

    Google Scholar 

  15. 15.

    Jones JS. Impaired sphincter control in the dyspnoeic. Lancet. 1977;2:532–3.

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Hrisanfow E, Hagglund D. Impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease. J Clin Nurs. 2013;22:97–105.

    Article  PubMed  Google Scholar 

  17. 17.

    Hirayama F, Lee AH, Hiramatsu T, Tanikawa Y. Breathlessness is associated with urinary incontinence in men: a community-based study. BMC Pulm Med. 2010;10:2.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Kupelian V, Rosen RC, Roehrborn CG, Tyagi P, Chancellor MB, McKinlay JB. Association of overactive bladder and C-reactive protein levels. Results from the Boston Area Community Health (BACH) Survey. BJU Int. 2012;110:401–7.

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Hsiao SM, Lin HH, Kuo HC. The role of serum C-reactive protein in women with lower urinary tract symptoms. Int Urogynecol J. 2012;23:935–40.

    Article  PubMed  Google Scholar 

  20. 20.

    Corsonello A, Pedone C, Battaglia S, Paglino G, Bellia V, Incalzi RA. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as inflammation markers in elderly patients with stable chronic obstructive pulmonary disease (COPD). Arch Gerontol Geriatr. 2011;53:190–5.

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Pinto-Plata VM, Mullerova H, Toso JF, Feudjo-Tepie M, Soriano JB, Vessey RS, et al. C-reactive protein in patients with COPD, control smokers and non-smokers. Thorax. 2006;61:23–8.

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Thom DH, Brown JS, Schembri M, Ragins AI, Subak LL, Van Den Eeden SK. Incidence of and risk factors for change in urinary incontinence status in a prospective cohort of middle-aged and older women: the reproductive risk of incontinence study in Kaiser. J Urol. 2010;184:1394–401.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Tashkin DP, Celli B, Senn S, Burkhart D, Kesten S, Menjoge S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008;359:1543–54.

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    D’Urzo AD, Rennard SI, Kerwin EM, Mergel V, Leselbaum AR, Caracta CF, et al. Efficacy and safety of fixed-dose combinations of aclidinium bromide/formoterol fumarate: the 24-week, randomized, placebo-controlled AUGMENT COPD study. Respir Res. 2014;15:123.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Singh D, Jones PW, Bateman ED, Korn S, Serra C, Molins E, et al. Efficacy and safety of aclidinium bromide/formoterol fumarate fixed-dose combinations compared with individual components and placebo in patients with COPD (ACLIFORM-COPD): a multicentre, randomised study. BMC Pulm Med. 2014;14:178.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. 26.

    ZuWallack R, Allen L, Hernandez G, Ting N, Abrahams R. Efficacy and safety of combining olodaterol Respimat® and tiotropium HandiHaler® in patients with COPD: results of two randomized, double-blind, active-controlled studies. Int J Chron Obstr Pulm Dis. 2014;9:1133–44.

    Article  CAS  Google Scholar 

  27. 27.

    Vestbo J, Anderson JA, Brook RD, Calverley PM, Celli BR, Crim C, et al. Fluticasone furoate and vilanterol and survival in chronic obstructive pulmonary disease with heightened cardiovascular risk (SUMMIT): a double-blind randomised controlled trial. Lancet. 2016;387:1817–26.

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775–89.

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Singh D, Papi A, Corradi M, Pavlisova I, Montagna I, Francisco C, et al. Single inhaler triple therapy versus inhaled corticosteroid plus long-acting beta2-agonist therapy for chronic obstructive pulmonary disease (TRILOGY): a double-blind, parallel group, randomised controlled trial. Lancet. 2016;388:963–73.

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Vestbo J, Papi A, Corradi M, Blazhko V, Montagna I, Francisco C, et al. Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial. Lancet. 2017;389:1919–29.

    Article  CAS  PubMed  Google Scholar 

  31. 31.

    Lipson DA, Barnacle H, Birk R, Brealey N, Locantore N, Lomas DA, et al. FULFIL trial: once-daily triple therapy for patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;196:438–46.

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Lipson DA, Barnhart F, Brealey N, Brooks J, Criner GJ, Day NC, et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med. 2018;378:1671–80.

    Article  CAS  PubMed  Google Scholar 

  33. 33.

    Papi A, Vestbo J, Fabbri L, Corradi M, Prunier H, Cohuet G, et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet. 2018;391:1076–84.

    Article  CAS  PubMed  Google Scholar 

  34. 34.

    Ferguson GT, Rabe KF, Martinez FJ, Fabbri LM, Wang C, Ichinose M, et al. Triple therapy with budesonide/glycopyrrolate/formoterol fumarate with co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease (KRONOS): a double-blind, parallel-group, multicentre, phase 3 randomised controlled trial. Lancet Respir Med. 2018;6:747–58.

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Rossi A, Kristufek P, Levine BE, Thomson MH, Till D, Kottakis J, et al. Comparison of the efficacy, tolerability, and safety of formoterol dry powder and oral, slow-release theophylline in the treatment of COPD. Chest. 2002;121:1058–69.

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Cazzola M, Calzetta L, Barnes PJ, Criner GJ, Martinez FJ, Papi A, et al. Efficacy and safety profile of xanthines in COPD: a network meta-analysis. Eur Respir Rev. 2018;27:180010.

    Article  PubMed  Google Scholar 

  37. 37.

    Devereux G, Cotton S, Fielding S, McMeekin N, Barnes PJ, Briggs A, et al. Effect of theophylline as adjunct to inhaled corticosteroids on exacerbations in patients with COPD: a randomized clinical trial. JAMA. 2018;320:1548–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Calverley PM, Sanchez-Toril F, McIvor A, Teichmann P, Bredenbroeker D, Fabbri LM. Effect of 1-year treatment with roflumilast in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007;176:154–61.

    Article  CAS  PubMed  Google Scholar 

  39. 39.

    Calverley PM, Rabe KF, Goehring UM, Kristiansen S, Fabbri LM, Martinez FJ, et al. Roflumilast in symptomatic chronic obstructive pulmonary disease: two randomised clinical trials. Lancet. 2009;374:685–94.

    Article  CAS  PubMed  Google Scholar 

  40. 40.

    Martinez FJ, Calverley PM, Goehring UM, Brose M, Fabbri LM, Rabe KF. Effect of roflumilast on exacerbations in patients with severe chronic obstructive pulmonary disease uncontrolled by combination therapy (REACT): a multicentre randomised controlled trial. Lancet. 2015;385:857–66.

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Martinez FJ, Rabe KF, Sethi S, Pizzichini E, McIvor A, Anzueto A, et al. Effect of roflumilast and inhaled corticosteroid/long-acting beta2-agonist on chronic obstructive pulmonary disease exacerbations (RE(2)SPOND). A randomized clinical trial. Am J Respir Crit Care Med. 2016;194:559–67.

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Hashimoto M, Hashimoto K, Ando F, Kimura Y, Nagase K, Arai K. Prescription rate of medications potentially contributing to lower urinary tract symptoms and detection of adverse reactions by prescription sequence symmetry analysis. J Pharm Health Care Sci. 2015;1:7.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Landefeld CS, Bowers BJ, Feld AD, Hartmann KE, Hoffman E, Ingber MJ, et al. National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008;148:449–58.

    Article  PubMed  Google Scholar 

  44. 44.

    Dubeau CE. The aging lower urinary tract. J Urol. 2006;175:S11–5.

    Article  PubMed  Google Scholar 

  45. 45.

    van Manen JG, Bindels PJ, Dekker FW, Bottema BJ, van der Zee JS, Ijzermans CJ, et al. The influence of COPD on health-related quality of life independent of the influence of comorbidity. J Clin Epidemiol. 2003;56:1177–84.

    Article  PubMed  Google Scholar 

  46. 46.

    Crisafulli E, Costi S, Luppi F, Cirelli G, Cilione C, Coletti O, et al. Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation. Thorax. 2008;63:487–92.

    Article  CAS  PubMed  Google Scholar 

  47. 47.

    Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23:322–30.

    Article  PubMed  Google Scholar 

  48. 48.

    The International Consultation on Incontinence Questionnaire. 2019. http://iciq.net. Accessed Feb 2019.

  49. 49.

    Newman DK. In men and women with COPD the presence of urinary incontinence is associated with poorer quality of life. Evid Based Nurs. 2014;17:22–3.

    Article  PubMed  Google Scholar 

  50. 50.

    Shamliyan T, Wyman JF, Ramakrishnan R, Sainfort F, Kane RL. Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review. Ann Intern Med. 2012;156(861–74):W301–10.

    Google Scholar 

  51. 51.

    Herschorn S, Kaplan SA, Sun F, Ntanios F. Do patient characteristics predict responsiveness to treatment of overactive bladder with antimuscarinic agents? Urology. 2014;83:1023–9.

    Article  PubMed  Google Scholar 

  52. 52.

    McVean RJ, Orr A, Webb AK, Bradbury A, Kay L, Philips E, et al. Treatment of urinary incontinence in cystic fibrosis. J Cyst Fibros. 2003;2:171–6.

    Article  CAS  PubMed  Google Scholar 

  53. 53.

    Kafri R, Deutscher D, Shames J, Golombp J, Melzer I. Randomized trial of a comparison of rehabilitation or drug therapy for urgency urinary incontinence: 1-year follow-up. Int Urogynecol J. 2013;24:1181–9.

    Article  PubMed  Google Scholar 

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Correspondence to Nicola Scichilone.

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SB, AB, SP, LB, and NS have no conflicts of interest to declare.

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Battaglia, S., Benfante, A., Principe, S. et al. Urinary Incontinence in Chronic Obstructive Pulmonary Disease: A Common Co-morbidity or a Typical Adverse Effect?. Drugs Aging 36, 799–806 (2019). https://doi.org/10.1007/s40266-019-00687-4

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