Thorax, Vol 52, 612-617, Copyright © 1997 by Thorax.

Drug use and pulmonary death rates in increasingly symptomatic asthma patients in the UK

CR Meier and H Jick
Boston Collaborative Drug Surveillance Program, Boston University Medical Center, Lexington, Massachusetts 02173, USA.

BACKGROUND: There is concern about an increase in deaths from respiratory causes in asthma patients using long acting beta agonists. According to the guidelines of the British Thoracic Society, long acting beta agonists, ipratropium bromide, and theophylline should be used to treat patients with increasing asthma severity who are already receiving treatment with short acting beta agonists and inhaled steroids. A study was therefore undertaken to compare the characteristics and short term respiratory mortality rates in first time users of one of these three drugs. METHODS: An open cohort study with a nested case-control analysis was performed on the UK based General Practice Research Database (GPRD). First time users of either salmeterol (n = 8386), ipratropium bromide (n = 4305), or theophylline (n = 4228) between 1 January 1992 and 30 April 1995 were identified and followed for 16 weeks. Drug usage patterns, predictors for respiratory mortality, and the number of deaths at 16 weeks in the three drug groups were compared. RESULTS: The three asthma drugs were most often prescribed to patients with severe asthma. Age, a concomitant diagnosis of chronic obstructive pulmonary disease or emphysema, number of asthma drug prescriptions, number of visits to the general practitioner, and whether or not the patient had been admitted to hospital due to the respiratory disease in the 12 months prior to the start of the new drug therapy were strong predictors for asthma mortality. After adjusting for several risk factors, the relative risk estimates of a respiratory death for ipratropium bromide and theophylline users compared with salmeterol users were 1.8 (95% CI 0.4 to 9.6) and 3.0 (95% CI 0.4 to 22.4), respectively. CONCLUSIONS: In the UK population studied, salmeterol, ipratropium bromide and theophylline are regularly used to treat patients with asthma of increasing severity. Salmeterol use was not associated with an increase in short term mortality compared with ipratropium bromide and theophylline.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Wijesinghe, M., Weatherall, M., Perrin, K., Harwood, M., Beasley, R. (2009). Risk of mortality associated with formoterol: a systematic review and meta-analysis. Eur Respir J 34: 803-811 [Abstract] [Full Text]  
• LANG, D. M. (2008). New asthma guidelines emphasize control, regular monitoring. Cleveland Clinic Journal of Medicine 75: 641-653 [Abstract] [Full Text]  
• Wijesinghe, M, Perrin, K, Harwood, M, Weatherall, M, Beasley, R (2008). The risk of asthma mortality with inhaled long acting {beta}-agonists. Postgrad. Med. J. 84: 467-472 [Abstract] [Full Text]  
• Bateman, E., Nelson, H., Bousquet, J., Kral, K., Sutton, L., Ortega, H., Yancey, S. (2008). Meta-analysis: Effects of Adding Salmeterol to Inhaled Corticosteroids on Serious Asthma-Related Events. ANN INTERN MED 149: 33-42 [Abstract] [Full Text]  
• Nelson, H. S., Weiss, S. T., Bleecker, E. R., Yancey, S. W., Dorinsky, P. M., the SMART Study Group, (2006). The Salmeterol Multicenter Asthma Research Trial: A Comparison of Usual Pharmacotherapy for Asthma or Usual Pharmacotherapy Plus Salmeterol. Chest 129: 15-26 [Abstract] [Full Text]  
• Anderson, H R., Ayres, J. G, Sturdy, P. M, Bland, J M., Butland, B. K, Peckitt, C., Taylor, J. C, Victor, C. R, for the Mortality and Severe Morbidity Group of th, (2005). Bronchodilator treatment and deaths from asthma: case-control study. BMJ 330: 117- [Abstract] [Full Text]  
• Schlienger, R. G., Jick, S. S., Meier, C. R. (2004). Inhaled Corticosteroids and the Risk of Fractures in Children and Adolescents. Pediatrics 114: 469-473 [Abstract] [Full Text]  
• Sin, D.D., Tu, J.V. (2001). Inhaled corticosteroid therapy reduces the risk of rehospitalization and all-cause mortality in elderly asthmatics. Eur Respir J 17: 380-385 [Abstract] [Full Text]  
• LANES, S. F., LANZA, L. L., WENTWORTH, C. E. III (1998). Risk of Emergency Care, Hospitalization, and ICU Stays for Acute Asthma among Recipients of Salmeterol. Am. J. Respir. Crit. Care Med. 158: 857-861 [Abstract] [Full Text]