The Pharmaceutical Journal
Vol 269 No 7209 p148
3 August 2002

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Reliever inhalers linked to increased asthma deaths

Increased risk of death from asthma is associated with excessive use of short-acting beta-agonist inhalers, according to a new study (Thorax 2002;57:683).

Researchers, funded by Boehringer Ingelheim, compared the risk of death among asthma patients who were taking specific drugs with that in asthma patients who were not. They included data on 96,000 asthma patients from the General Practice Research Database.

The researchers observed that increasing use of asthma medication was associated with an increased risk of death from asthma. After adjustment for confounding factors, including frequency of consultation or hospital admission for asthma, the relative risks associated with most respiratory drugs investigated, such as long-acting beta-agonsits and theophyllines, fell. However, This was not the case for short-acting beta-agonists.

Patients who had received seven to 12 prescriptions for symptom-relieving short-acting beta-agonist inhalers within the past year had a 16-fold increased risk of death compared with those not taking these drugs. The risk of death among patients who received 13 or more prescriptions for these inhalers increased by over 50-fold.

Conversely, longer-acting inhaled steroids were associated with a decreased risk of death from asthma and patients who were prescribed more than one short-acting inhaler a month, cut their risk of death by 60 per cent if they regularly used a long-acting inhaled steroid as well.

The researchers suggest that high-risk asthma patients who over-use short-acting beta-agonists might be at increased risk because they use fewer long-acting inhaled steroids. However, their analyses show that patients who used short-acting inhalers were just as likely to use steroid inhalers for symptom prevention.

The researchers suggest that deaths due to chronic obstructive pulmonary disease could have been misclassified as asthma deaths, since this disease is more common in the elderly and 35 of the 43 asthma deaths in the study were people aged 50 years or over.