Inhaled bronchodilators and the risk of tachyarrhythmias.
OBJECTIVE
There have been controversies about whether inhaled bronchodilators could increase the risk of clinically important tachyarrhythmias. We investigated the association between inhaled bronchodilators and the development of tachyarrhythmias, including atrial fibrillation and other paroxysmal tachyarrhythmias in real practice.


METHODS
We conducted a nested case-control study with the use of the nationwide insurance claims database of the Health Insurance Review and Assessment Service (Seoul, Republic of Korea). Overall, 3312 cases with newly developed tachyarrhythmias including atrial fibrillation and other paroxysmal tachyarrhythmias and 9732 matched (up to 1:5) controls were identified from 545,508 subjects without acute major cardiovascular events in the past year between January 1, 2011 and December 31, 2011. Conditional logistic regression analysis adjusted by comorbidities, cardiovascular drugs and healthcare utilization was performed.


RESULTS
In various multivariate models, the use of inhaled long-acting muscarinic antagonists (LAMAs) or long-acting inhaled β2 agonists (LABAs) was significantly associated with tachyarrhythmias. Statistically significant effects of LAMAs on tachyarrhythmias were found only in the non-users of β-blockers. We did not find a statistically significant difference in the impact of a LABA without a LAMA vs a LAMA without a LABA (aOR, 0.93; 95% CI, 0.74-1.18), or a multiplicative or additive interaction between a LABA and a LAMA.


CONCLUSIONS
Inhaled LAMAs and LABAs were significantly and comparably associated with an increased risk of tachyarrhythmias.
National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Chang-Hoon
CH
Lee
National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Real Estate R&D Institute, Korea Appraisal Board, Daegu, Republic of Korea.
Seongmi
S
Choi
National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Department of Information Statistics, College of Natural Science, Andong National University, Andong, Republic of Korea.
Eun Jin
EJ
Jang
Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Han-Mo
HM
Yang
National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea.
Ho Il
HI
Yoon
National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
Yun Jung
YJ
Kim
National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
Jimin
J
Kim
National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Jae-Joon
JJ
Yim
National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea. Electronic address: kimdkmd@gmail.com.
Deog Kyeom
DK
Kim
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D013610:Tachycardia / Q000139:chemically induced* / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
D001993:Bronchodilator Agents
Inhaled muscarinic antagonists; Inhaled β2 agonists; Tachyarrhythmias