Association of Frequent Short-Acting Beta-Agonist Inhaler Prescriptions with Acute Cardiovascular Events

Abstract

BACKGROUND: Frequent usage of short-acting beta-agonist (SABA) reliever inhalers is strongly associated with exacerbations of asthma and chronic obstructive pulmonary disease (COPD), in turn associated with cardiovascular events. Patients with high SABA usage commonly report symptoms of heart racing and palpitations. However, many patients who overuse SABA inhalers have no history of frequent exacerbations, and the cardiovascular risks of SABA overuse in these patients has been poorly described to date. AIM: To establish whether frequent SABA usage is associated with adverse acute cardiovascular events (ACE) in patients who do not have a history of frequent exacerbations requiring oral corticosteroids. METHODS: A case-series analysis was conducted with ACE as the event and SABA prescription as the exposure, comparing 3-month quarters with frequent SABA prescription to quarters with no SABA prescription, using primary care data from the Optimum Patient Care Research Database (OPCRD). RESULTS: About 97082 patients with at least one period of frequent SABA prescription and who had no more than one exacerbation requiring oral corticosteroids prior to first ACE formed the primary analysis population, and 63824 patients who had no oral corticosteroids prior to first ACE were included in a sensitivity analysis. A significantly increased incidence of ACE was evident during quarters in which SABA inhalers were prescribed compared to quarters without SABA prescription, with Incidence Rate Ratio (IRR) 1.80 (95% CI 1.70-1.89) for the primary analysis; IRR 2.20 (95% CI 2.02-2.46) for the sensitivity analysis. A clear dose response was evident with increasing risk as the number of SABA prescribed per quarter increased. CONCLUSION: Frequent SABA usage appears to be associated with an increased risk of ACE even in patients not having oral corticosteroids for exacerbations of asthma or COPD. The risks of frequent SABA usage need both further research and clinical consideration, and prescription of frequent SABA inhalers should not be viewed as a benign prescription.