Author: Salpeter S.R.

Source: Drugs & Aging, Volume 21, Number 6, 2004 , pp. 405-414(10)

Publisher: Adis International

Abstract:

Background: ₂-Adrenoceptor agonists have been used as bronchodilators in the management of asthma and chronic obstructive pulmonary disease (COPD); however, there is evidence suggesting that ₂-adrenoceptor agonist use may increase morbidity and mortality.

Methods: A systematic review of case-control studies and randomised controlled trials was performed to evaluate the cardiovascular safety of ₂-adrenoceptor agonist use in patients with obstructive airway disease, defined as asthma or COPD.

Results: Case-control studies have shown that ₂-adrenoceptor agonist use is associated with an increased risk of myocardial infarction, congestive heart failure, cardiac arrest and sudden cardiac death. The degree of risk appears to be dose-dependent, and may be highest for new users and those with concomitant cardiac conditions. Pooled data from randomised placebo-controlled trials indicate that ₂-adrenoceptor agonist use increases the risk of adverse cardiovascular events by more than 2-fold compared with placebo, thus providing evidence that the association seen in case-control studies is a causal one. Single doses of ₂-adrenoceptor agonists significantly increase heart rate and decrease potassium concentrations compared with placebo.

Conclusions: Initiation of ₂-adrenoceptor agonist treatment increases heart rate and decreases potassium concentrations, while continued use may increase the risk of adverse cardiovascular events. It could be through these effects of -adrenergic stimulation that ₂-adrenoceptor agonists may induce ischaemia, congestive heart failure, arrhythmias and sudden cardiac death. In addition to increasing adverse cardiovascular events, ₂-adrenoceptor agonist use may induce respiratory tolerance and increase the risk of asthma attacks. It is not clear whether ₂-adrenoceptor agonists should be used regularly in the treatment of obstructive airway disease, with or without concomitant cardiovascular disease.

Keywords: Elderly; Chronic obstructive pulmonary disease, treatment; Asthma, treatment; Beta adrenoceptor agonists, adverse reactions

Document Type: Research article

Publication date: 2004-01-01

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