Bronchodilator treatment and deaths from asthma: case-control study.
OBJECTIVE
To investigate the association between bronchodilator treatment and death from asthma.


METHODS
Case-control study.


METHODS
33 health authorities or health boards in Great Britain.


METHODS
532 patients under age 65 who died from asthma and 532 controls with a hospital admission for asthma matched for period, age, and area.


METHODS
Odds ratios for deaths from asthma associated with prescription of bronchodilators and other treatment, with sensitivity analyses adjusting for age at onset, previous hospital admissions, associated chronic obstructive lung disease, and number of other drug categories.


RESULTS
After full adjustment, there were no significant associations with drugs prescribed in the 4-12 months before the index date. For prescriptions in the 1-5 years before, mortality was positively associated with inhaled short acting beta2 agonists (odds ratio 2.05, 95% confidence interval 1.26 to 3.33) and inversely associated with antibiotics (0.59, 0.39 to 0.89). The former association seemed to be confined to those aged 45-64, and the association with antibiotics was more pronounced in those under 45. Significant age interactions across all periods suggested inverse associations with oral steroids confined to the under 45 age group. An inverse association with long acting beta2 agonists and a positive association with methylxanthines in the 1-5 year period were non-significant.


CONCLUSIONS
There was no evidence of adverse effects on mortality with medium to long term use of inhaled long acting beta2 agonist drugs. The association with short acting beta(2) agonists has several explanations, only one of which may be a direct adverse effect.
Anderson
H Ross
HR
Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE. r.anderson@sghms.ac.uk
Ayres
Jon G
JG
Sturdy
Patricia M
PM
Bland
J Martin
JM
Butland
Barbara K
BK
Peckitt
Clare
C
Taylor
Jennifer C
JC
Victor
Christina R
CR
D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000009:adverse effects*; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D018927:Anti-Asthmatic Agents / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy* / Q000401:mortality*; D001993:Bronchodilator Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000009:adverse effects*; D016017:Odds Ratio; D012044:Regression Analysis; D006113:United Kingdom / Q000453:epidemiology
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists