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Cardiovascular side effects of inhaled salbutamol in hypoxic asthmatic patients
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  1. J Burggraafa,
  2. R G J Westendorpc,
  3. J C C M in‘t Veenb,
  4. R C Schoemakera,
  5. P J Sterkb,
  6. A F Cohena,
  7. G J Blauwc
  1. aCentre for Human Drug Research, Zernikedreef 10, 2333 CL Leiden, The Netherlands, bDepartment of Pulmonology, Leiden University Medical Center, cDepartment of General Internal Medicine, Leiden University Medical Center
  1. Dr J Burggraafkb{at}chdr.nl

Abstract

BACKGROUND Beta-2 adrenoceptor agonists have been associated with sudden death in asthma patients but the cause and underlying mechanism are unclear. Animal experiments indicate that the combination of hypoxia and β2 agonists may result in detrimental cardiovascular effects. A study was undertaken to investigate the effect of hypoxia on the systemic vascular effects of salbutamol in patients with asthma who are hypoxic by assessing forearm blood flow (FBF) as a measure of peripheral vasodilatation.

METHODS Eight men with mild asthma underwent the following treatments: normoxia + placebo (NP), normoxia + salbutamol (NS), hypoxia + placebo (HP), and hypoxia + salbutamol (HS). The period of mask breathing started at t=0 minutes, lasted for 60 minutes, and at 30 minutes 800 μg salbutamol was inhaled. The experiment was completed 30 minutes after the inhalation (t=60 minutes). For the hypoxia treatment the Spo 2 level was 82%. Differences between treatments were sought using factorial ANOVA on percentage change from the pretreatment value.

RESULTS There were no significant differences in blood pressure and potassium levels between the treatments. After 60 minutes the increase in FBF was 13% (95% CI –12 to 39) more for HP treatment than for NP, 21% (95% CI –5 to 46) more for NS than for NP, and 32% (95% CI 7 to 58) more for HS than for HP (p=0.016). The inhalation of salbutamol during hypoxia resulted in a significant increase in FBF of 45% (95% CI 20 to 71) compared with NP (p=0.001).

CONCLUSION Patients with asthma who are hypoxic and inhale β2 agonists have serious systemic vascular side effects which may be an additional explanation for the association between asthma treatment and sudden death.

  • asthma
  • hypoxia
  • β2agonists

https://doi.org/10.1136/thx.56.7.567

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