Inhaled beta-2 adrenergic receptor agonists and primary cardiac arrest.
OBJECTIVE
We sought to investigate if short-acting, inhaled beta2-adrenergic receptor agonists were associated with higher risk of primary cardiac arrest in patients with asthma or chronic obstructive pulmonary disease (COPD).


METHODS
We conducted a population-based study involving 454 patients enrolled in a health maintenance organization, aged 40 to 79 years, who had asthma or COPD and who experienced primary cardiac arrest during 1980 to 1994. We randomly selected 586 controls from strata of enrollees, defined by age, sex, calendar year, and prior heart disease. Medication use was assessed from computerized pharmacy data, and risk factors from medical record review.


RESULTS
Use of inhaled beta-agonists was associated with a twofold increased risk of primary cardiac arrest (odds ratio [OR] = 1.9; 95% confidence interval [CI]: 1.1 to 3.3) among patients with asthma, but not among those with COPD (OR = 1.3; 95% CI: 0.6 to 2.7), after adjustment for risk factors. This association was observed only with use of two or more canisters of metered-dose, inhaled beta-agonists for 3 months, and when inhaled steroids were not used.


CONCLUSIONS
These results support current guidelines recommending inhaled steroids as first-line asthma therapy.
Lemaitre
Rozenn N
RN
Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington 98101, USA. rozenl@u.washington.edu
Siscovick
David S
DS
Psaty
Bruce M
BM
Pearce
Rachel M
RM
Raghunathan
Trivellore E
TE
Whitsel
Eric A
EA
Weinmann
Sheila A
SA
Anderson
Gail D
GD
Lin
Danyu
D
D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001249:Asthma / Q000188:drug therapy*; D016022:Case-Control Studies; D005260:Female; D006279:Health Maintenance Organizations; D006323:Heart Arrest / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D018343:Receptors, Adrenergic, beta-2 / Q000187:drug effects; D012307:Risk Factors
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D018343:Receptors, Adrenergic, beta-2