Dysrhythmogenesis associated with the treatment of acute reversible airway obstruction

The management of acute reversible airway obstruction of asthma and chronic obstructive pulmonary disease (COPD) relies substantially on use of sympathomimetics and/or methylxanthines. In spite of deeply ingrained clinical "impressions" regarding the relative safety of these agents, singly or in combination, their cardiotonic and dysrhythmogenic properties - particularly in the setting of hypoxemia - are not well documented. Even the newer "selective" B2 agonists have not been shown to evoke less cardiac effect (as manifested by tachycardia or dysrhythmogenesis) than their by now somewhat maligned and ignored cousin, epinephrine. The limited number of clinical studies which have examined this area are reviewed and suggestions for clinical practice are offered.