In the JournalsPerspective

Asthma relapse more likely after use of short-acting beta-2 agonists

Children who took short-acting beta-2 agonists within 6 hours before hospital admission and the presence of retractions on physical examinations increased their risk for relapse after the treatment for asthma exacerbations, according to data.

“In patients who are discharged from an emergency department after an asthma attack, those who took short-acting beta-2 agonists before admissions should be followed up closely because of the possibility of relapse,” researchers wrote.

Erdem Topal, MD, of the department of pediatric allergy and asthma at the Gazi University in Ankara, Turkey, and colleagues conducted the multicenter, prospective study of children with asthma attacks (n=1,177; aged 6 months to 17 years) with a mean age of 70.72 months.

Within 1 week after hospital discharge, 199 (16.9%) patients relapsed, according to researchers.

“In our study, use of accessory respiratory muscles at admission increased the relapse rate by 1.76-fold,” they wrote.

Logistic regression models allowed for the identification of factors that were independently associated with relapse, including: having taken a short-acting inhaled beta-2 agonist within 6 hours before admission (OR=2.43; 95% CI, 1.728-3.426); the presence of retraction on physical examination (OR=1.76; 95% CI, 1.123-2.774); no prescription for high-dose inhaled steroids on release (OR=2.02; 95% CI, 1.37-3.002); and not being given a written instructional plan (OR=1.55; 95% CI, 1.08-2.226), according to data.

The researchers said their results could not be generalized because of study limitations, including a lack of other environmental factors being considered and a limited number of patients from various areas. Patients who have taken short-acting beta-2 agonists before hospitalization should be followed-up due to the risk for relapse, they concluded.

Disclosure: The researchers report no relevant financial disclosures.

Children who took short-acting beta-2 agonists within 6 hours before hospital admission and the presence of retractions on physical examinations increased their risk for relapse after the treatment for asthma exacerbations, according to data.

“In patients who are discharged from an emergency department after an asthma attack, those who took short-acting beta-2 agonists before admissions should be followed up closely because of the possibility of relapse,” researchers wrote.

Erdem Topal, MD, of the department of pediatric allergy and asthma at the Gazi University in Ankara, Turkey, and colleagues conducted the multicenter, prospective study of children with asthma attacks (n=1,177; aged 6 months to 17 years) with a mean age of 70.72 months.

Within 1 week after hospital discharge, 199 (16.9%) patients relapsed, according to researchers.

“In our study, use of accessory respiratory muscles at admission increased the relapse rate by 1.76-fold,” they wrote.

Logistic regression models allowed for the identification of factors that were independently associated with relapse, including: having taken a short-acting inhaled beta-2 agonist within 6 hours before admission (OR=2.43; 95% CI, 1.728-3.426); the presence of retraction on physical examination (OR=1.76; 95% CI, 1.123-2.774); no prescription for high-dose inhaled steroids on release (OR=2.02; 95% CI, 1.37-3.002); and not being given a written instructional plan (OR=1.55; 95% CI, 1.08-2.226), according to data.

The researchers said their results could not be generalized because of study limitations, including a lack of other environmental factors being considered and a limited number of patients from various areas. Patients who have taken short-acting beta-2 agonists before hospitalization should be followed-up due to the risk for relapse, they concluded.

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Andy Nish

    Andy Nish

    It is useful to know which clinical indicators might predict a relapse so that we can treat those patients stronger and longer, if you will, to hopefully prevent that relapse. It was interesting that they noted themselves that their data may not be translatable to other situations because they didn’t control for certain factors such as environmental variables. However, it does make sense on the face of it, that at least those two indicators they mention primarily, which included the use of beta-agonist within 6 hours of presentation to emergency room and the presence of retractions would indicate it might be a more severe exacerbation of asthma than otherwise. It wouldn’t be surprising that those patients might be more likely to relapse.

    I would be curious to see if there was a dose response relationship between how many doses of bronchodilator they had prior to presentation in the emergency room and prior to relapse. Previous studies have shown that chronic use of beta-agonists may serve to down regulate the receptors and make the lungs less responsive to subsequent doses of beta-agonists. Other studies have shown that the over usage of beta-agonists, which may lead to a delay in seeking treatment, mayalso be associated with increased morbidity and mortality.

    • Andy Nish, MD
    • Medical Director of NGPG Allergy and Asthma
      Gainesville, GA

    Disclosures: Nish reports no relevant financial disclosures.