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Changing patterns in asthma morbidity and mortality

M R Sears1

  • 1McMaster University, Hamilton, Ontario, Canada.

Journal of Investigational Allergology & Clinical Immunology
|March 1, 1995
PubMed
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Frequent use of inhaled beta-agonists, like fenoterol and salbutamol, is linked to increased asthma severity, morbidity, and mortality. This suggests a potential shift in chronic asthma control, even with corticosteroid treatment.

Area of Science:

  • Pulmonology
  • Clinical Pharmacology

Background:

  • Asthma morbidity and mortality rates have risen globally over the past decade.
  • Epidemics of asthma deaths have been observed in some regions, alongside gradual increases elsewhere.

Purpose of the Study:

  • To investigate the association between specific bronchodilator use and asthma-related mortality and morbidity.
  • To evaluate the impact of frequent beta-agonist use on asthma control and severity.

Main Methods:

  • Case-control studies analyzing prescription data and asthma mortality.
  • Randomized, placebo-controlled crossover study comparing regular versus as-needed beta-agonist use.
  • Analysis of factors associated with asthma mortality, including severity assessment and treatment adherence.

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Main Results:

  • Fenoterol prescription was linked to higher asthma death risk compared to salbutamol.
  • Increased risk of asthma exacerbation and death was associated with both fenoterol and salbutamol, particularly at higher doses.
  • Regular beta-agonist use, even with inhaled corticosteroids, led to increased asthma symptoms, reduced lung function, and heightened airway responsiveness.

Conclusions:

  • Frequent use of inhaled beta-agonists, especially potent ones, may have a deleterious effect on asthma control.
  • This frequent use appears to contribute to increased chronic asthma severity, leading to higher morbidity and mortality.
  • Underassessment of severity, undertreatment with corticosteroids, and overreliance on bronchodilators are critical factors in asthma mortality.