The association between beta-agonist use and death from asthma. A meta-analytic integration of case-control studies
M. Mullen, B. Mullen and M. Carey
American Lung Association of Central New York, Syracuse 13217-6409.
OBJECTIVES--The purpose of this investigation was to provide an empirical
summary of the evidence regarding the association between beta-agonist use
and death from asthma. This effort integrated the results of case-control
studies that examined the use of beta-agonists among asthmatic patients who
died and the use of beta-agonists among asthmatic patients who did not die.
The possible moderating effects of patient sample age and mode of delivery
(oral, metered-dose inhaler, and nebulizer) were also examined. DATA
SOURCES--An on-line computer search (using MEDLINE) was conducted using the
key words beta-agonist and asthma. This search was supplemented by ancestry
and descendency approach searches. Studies that were available as of April
1992 were eligible for inclusion in this integration. STUDY
SELECTION--Studies were included if they reported the precise numbers of
cases and controls who did and did not use a beta-agonist. A total of six
case-control studies comprising 15 separate tests of the relation between
beta-agonist use and death from asthma and data for 364 cases and 1388
controls were included. DATA EXTRACTION--The 2 (case vs control) x 2 (did
vs did not use beta-agonist) designs allowed for direct derivation of a chi
2 statistic that tested the association between beta-agonist use and death
from asthma. Mode of delivery and average age of sample were also coded.
DATA SYNTHESIS--Statistical integration revealed a significant, although
extremely weak, relation between beta-agonist use and death from asthma (z
= 3.996; P = .000075; mean r = .055). This relation emerged only when
beta-agonists were administered with a nebulizer (z = 4.481; P = .0000038;
mean r = .103). There was no association between beta-agonist use and death
when beta-agonists were administered by metered-dose inhaler (z = 1.194; P
= .11; mean r = .031) or orally (z = 1.247; P = .1; mean r = .031). Adults
were more likely than adolescents to evidence the association between
beta-agonist use and death. CONCLUSIONS--These results document the
extremely small magnitude of the relation between beta-agonist use and
death from asthma. Furthermore, these results specify that the weak
relation between beta-agonist use and death from asthma may really be
restricted to the delivery of beta-agonists with a nebulizer. These
findings suggest that the headlines that followed the report by Spitzer et
al (1992) were misleading.
Regular Use of Corticosteroids and Low Use of Short-Acting {beta}2-Agonists Can Reduce Asthma Hospitalization
Senthilselvan et al.
Chest 2005;127:1242-1251.
ABSTRACT
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{beta}2-Agonists: Deja vu All Over Again : The Second-Generation Controversy
Bernstein
Chest 2002;122:763-765.
FULL TEXT
Clinical trial end points: On the road to nowhere?
Holloway and Dick
Neurology 2002;58:679-686.
ABSTRACT
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The Management of Acute Severe Asthma
Kelly
Journal of Pharmacy Practice 2001;14:91-107.
ABSTRACT
On demand use of {beta}2-agonists led to better asthma control than regular use in moderate to severe asthma
Quarton
Evid. Based Nurs. 2001;4:14-14.
FULL TEXT
Safety of Over-the-Counter Inhalers for Asthma : Report of the Council on Scientific Affairs
Dickinson et al.
Chest 2000;118:522-526.
ABSTRACT
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Compliance With National Asthma Management Guidelines and Specialty Care: A Health Maintenance Organization Experience
Legorreta et al.
Arch Intern Med 1998;158:457-464.
ABSTRACT
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beta 2-Agonist Metered Dose Inhaler Overuse: Psychological and Demographic Profiles
Beausoleil et al.
Pediatrics 1997;99:40-43.
ABSTRACT
| FULL TEXT
Controversies in Management: Adverse effects are not proved
Fuller
BMJ 1994;309:795-796.
FULL TEXT
ASTHMA MORTALITY RISK FROM BETA-AGONISTS IS EXAGGERATED
JWatch General 1993;1993:1-1.
FULL TEXT
