SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
11/5/04
Effects of maintenance use of albuterol
Summary
Background - Some studies, but not all, have shown major adverse clinical outcomes in those asthmatics treated chronically on a regular basis with inhaled short acting beta agonists such as albuterol (Alb). Some findings suggest that such adverse effects of Alb may occur more in patients with a homozygous arginine (Arg/Arg) instead of glycine (Gly/Gly) at amino acid residue #16 of the beta-adrenergic receptor.
Findings - Israel et al carried out a masked, crossover study comparing regular use of inhaled Alb vs placebo over a 16 week period in a group of mild asthmatics who were either Arg/Arg (n=37) or Glyc/Glyc) (n=41) genotype in the beta-adrenergic receptor. They found that the morning peak expiratory flow rate (PEFR) of the Glyc/Glyc patients was 14L/min more after Alb than placebo treatment; (p=0.02). In contrast, the PEFR was actually 10L/min less after Alb treatment than after placebo treatment in the Arg/Arg patients; (p=0.02). This pattern of different responses to Alb in Glyc/Glyc and Arg/Arg patients was also seen in assessments of FEV-1, symptom scores, and use of supplemental reliever medication.
Conclusions - Adverse effects of regular use of inhaled Alb in asthmatics occurs in those with the Arg/Arg genotype. Reference
Lancet 2004;364:1505-12
Editor's Comments
These findings suggest that adverse effects of the regular use of inhaled Alb in asthma may be limited to a patient sub-population with a particular genotype. The differences in responses of the Glyc/Glyc and Arg/Arg patients in this study were not striking (mean total difference = 24L/min in the morning PEFR). However, such differences may explain different findings in various previous studies investigating possible adverse effects of inhaled Alb.
|