Chest
Special ReportCardiovascular Effects of β-Agonists in Patients With Asthma and COPD: A Meta-Analysis
Section snippets
Search Strategy
A comprehensive search of the EMBASE, MEDLINE, and CINAHL databases was performed to identify randomized placebo-controlled trials on β-agonist use in patients with obstructive airway disease, published between 1966 and June 2003. The search was performed using the terms bronchodilator, sympathomimetic, adrenergic β-agonist, albuterol, salbutamol, bitolterol, isoetharine, metaproterenol, salmeterol, terbutaline, fenoterol, formoterol, procaterol, isoproterenol, reproterol, eformoterol, or
Search Results
The electronic database search identified approximately 5,000 articles, and, of these, 185 were randomized, placebo-controlled trials of β2-agonist use in patients with obstructive airway disease. After scanning references from selected articles, an additional six potentially relevant trials were identified. Of these 191 studies, 13 single-dose trials and 20 longer duration trials met the inclusion criteria. The κ-statistic for interrater agreement on study eligibility was 0.98 (95% confidence
DISCUSSION
In summary, the initiation of β2-agonist therapy was associated with significant increases in heart rate and reductions in potassium concentrations, which are known to be common systemic effects of β-adrenergic stimulation, compared to placebo. With continued treatment, the rate of cardiovascular events was increased compared to placebo, with a significant increase in sinus tachycardia and a nonsignificant trend toward an increase in major cardiovascular events. It is possible that β2-agonists
ACKNOWLEDGMENT
We thank Donald Miller for his graphical assistance, and Christopher Stave for coordinating the trials search.
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