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Bronchodilator treatment and deaths from asthma: case-control study

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38316.729907.8F (Published 13 January 2005) Cite this as: BMJ 2005;330:117
  1. H Ross Anderson (r.anderson{at}sghms.ac.uk), professor of epidemiology and public health1,
  2. Jon G Ayres, professor of environmental and occupational medicine2,
  3. Patricia M Sturdy, senior research fellow1,
  4. J Martin Bland, professor of medical statistics1,
  5. Barbara K Butland, lecturer in medical statistics1,
  6. Clare Peckitt, statistician1,
  7. Jennifer C Taylor, research manager1,
  8. Christina R Victor, professor of social gerontology,for the Mortality and Severe Morbidity Group of the National Asthma Task Force1
  1. 1Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE,
  2. 2Department of Environmental and Occupational Medicine, Liberty Safe Work Research Centre, University of Aberdeen, Aberdeen AB25 2ZP
  1. Correspondence to: H R Anderson
  • Accepted 23 November 2004

Abstract

Objective To investigate the association between bronchodilator treatment and death from asthma.

Design Case-control study.

Setting 33 health authorities or health boards in Great Britain.

Participants 532 patients under age 65 who died from asthma and 532 controls with a hospital admission for asthma matched for period, age, and area.

Main outcome measures Odds ratios for deaths from asthma associated with prescription of bronchodilators and other treatment, with sensitivity analyses adjusting for age at onset, previous hospital admissions, associated chronic obstructive lung disease, and number of other drug categories.

Results After full adjustment, there were no significant associations with drugs prescribed in the 4-12 months before the index date. For prescriptions in the 1-5 years before, mortality was positively associated with inhaled short acting β2 agonists (odds ratio 2.05, 95% confidence interval 1.26 to 3.33) and inversely associated with antibiotics (0.59, 0.39 to 0.89). The former association seemed to be confined to those aged 45-64, and the association with antibiotics was more pronounced in those under 45. Significant age interactions across all periods suggested inverse associations with oral steroids confined to the under 45 age group. An inverse association with long acting β2 agonists and a positive association with methylxanthines in the 1-5 year period were non-significant.

Conclusion There was no evidence of adverse effects on mortality with medium to long term use of inhaled long acting β2 agonist drugs. The association with short acting β2 agonists has several explanations, only one of which may be a direct adverse effect.

Footnotes

  • Contributors All authors contributed to the drafting of the final paper. Additionally, HRA was principal investigator and contributed to all stages of the study, PMS contributed to the entire conduct of the study, JMB contributed to the design and analysis, BKB designed, supervised, and contributed to the statistical analysis, CP contributed to the statistical analysis, JCT contributed to the conduct of the study in the field, CRV and JGA contributed to the design of the study and interpretation of data. HRA is guarantor.

  • Funding UK Department of Health, national research and development programme (contract AM1/05/002) and UK National Asthma Campaign, through a grant from GlaxoSmithKline. No part of the design, conduct, analysis, or interpretation of the study was influenced by the funders. Comment on an early draft of this report was received from GlaxoSmithKline. This drew attention to an arithmetical error in one of the tables and raised one point of clarification.

  • Competing interests HRA has received funding for epidemiological research into asthma from GlaxoSmithKline in the past. BKB owns shares in GlaxoSmithKline. JGA has received funding from various pharmaceutical companies for attending meetings, advisory work, and research

  • Ethical approval This study was approved by the South Thames multicentre research ethics committee and all relevant local ethics committees.

  • Accepted 23 November 2004
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