Asthma Meds May Be Linked to Irregular Heartbeat

TUESDAY, May 22 (HealthDay News) — New research suggests that
young asthma patients who use drugs known as inhaled anticholinergics
such as ipratropium [Atrovent] — could be more likely than others to
suffer from potentially dangerous irregular heartbeat.

However, the increased risk was not seen for some types of
anticholinergics.

“Obviously, this finding raises concern because of the recent interest
in use of anticholinergics in asthma,” study author Todd Lee of the
University of Illinois at Chicago, said in a news release from the
American Thoracic Society.

Still, “while we did find an increase in the risk of events associated
with the use of anticholinergics, the overall number of events we found
was relatively small,” Lee said. “Therefore, the absolute risk of an event
for an individual patient is relatively low.”

Asthma patients use anticholinergic drugs when they have flare-ups to
get quick relief. The medications have shown promise for use in the long
term to prevent exacerbations, the release noted.

But based on research with patients who have chronic obstructive
pulmonary disease, scientists wonder if the drugs could boost the risk of
heart problems. In the new study, researchers studied data on more than
280,000 asthma patients aged 5 to 24. They found 7,656 new users of asthma
drugs who had at least 6 months’ usage and compared them to about 76,000
other patients.

The researchers found that those who used the drugs faced a risk of
irregular heartbeat. The abstract of the study doesn’t say how many
developed the problem, but reports that the anticholinergic users had 1.56
times the risk of non-users.

The type of anticholingeric drug used made a difference. No signficant
risk was seen for tiotropium (Spiriva) or with ipratropium when it was
combined with other asthma drugs called short-acting beta agonists, like
albuterol.

The increased risk was only seen with higher anticholinergic doses.

It’s also not clear if the drugs are directly responsible for any
increased risk. While the study found an association between
anticholinergic use and irregular heartbeats, it did not prove a
cause-and-effect relationship.

Dr. Alan Baptist, an assistant professor of allergy and immunology at
the University of Michigan, said the study is useful, but cautioned that
the patients who took the drugs — which are typically considered a
secondary option after other drugs — might differ from other asthma
patients.

“For example, patients are sometimes given ipratropium because they
complain of ‘racing heart’ with albuterol, the first-line therapy,”
Baptist said. “Therefore, perhaps those patients given anticholinergics
were at an increased baseline risk for an arrhythmia even before they
received the anticholinergic.”

What should doctors and patients do? “Always consider the risks and
benefits of medications, step down medication level when asthma control is
reached, and use the lowest dose possible,” he said.

The study was scheduled for release Tuesday at an American Thoracic
Society conference in San Francisco. The data and conclusions should be
viewed as preliminary until published in a peer-reviewed journal.

More information

For more about asthma, check the U.S. National Library of Medicine.

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