Excessive use of ‘reliever’ inhalers linked to increased risk of death from asthma

Excessive use of ‘reliever’ inhalers for asthma is linked to a significantly increased risk of dying from the disease, finds research in Thorax.

The researchers based their findings on over 96,000 patients diagnosed with asthma whose details had been entered anonymously onto the General Practice Research Database between 1994 and 1998.

They calculated the relative risk of dying from asthma – risk for someone with taking a particular medication, compared with someone not taking that drug – for beta agonists, the short acting reliever drugs, and inhaled steroids, the long acting ‘preventer’ drugs.

Forty three people died as a result of their asthma; 35 of the deaths were in people aged 50 and above.

After adjusting the figures to take account of age, sex, weight, smoking, frequency of visits to a family or specialist doctor, and hospital admissions, relative risks for respiratory drugs used fell substantially. This suggests that the risk associated with certain drugs may be attributed to the drugs being used more often by patients with the greatest risk of death, say the authors.

But this was not the case for short acting beta agonists, which were much more strongly associated with the risk of dying from asthma. Between seven and 12 prescriptions of this type of inhaler in the previous year increased the risk of death 16-fold; 13 or more prescriptions increased it by over 50-fold.

The findings were not attributable to patients using inhalers for symptom relief being less likely to use inhalers for symptom prevention. But the researchers found that patients prescribed more than one short acting inhaler a month cut their risk of death by 60 per cent if they regularly used a long acting inhaled steroid inhaler.