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However, theophylline is not very effective and can cause significant side effects, so today the drug is seldom used in treating COPD.

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Glucocorticoids and LABAs, as well as most pulmonary medications, were continued throughout the trial, as detailed in Methods.

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These included potentially biased study selection, which was limited to trials reporting cardiovascular events; lack of assessment of patient follow-up time, with no accounting for differential discontinuation rates, which were significantly higher among patients given placebo (patients who continue to take placebo may be generally healthier than those who stop taking it, and potential differences in baseline cardiovascular risk factors were not accounted for in the analysis); lack of information on occurrence of adverse events in patients who withdrew from many of the included trials; lack of patient-level data; and the fact that trials on short-acting and long-acting anticholinergics were combined in the main analysis.

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