Three GPs on jury service proves trial for practice
Patients with COPD who take beta-agonists are at substantially increased risk of dying and require 'intensive medical attention', a controversial new study warns.
High users of the drugs were at up to a seven-fold increased risk of sudden death or death from cardiac arrest, Canadian researchers found.
'It's a warning. If they use more than [about] four puffs of beta-agonist a day the physician should look at the drugs the patient is taking,' said study team member Odile Sheehy, senior biostatistician at Centre Hospitalier Universitaire de Montreal.
She added: 'It's the responsibility of the physician to explain to the patient the risk of these drugs. They have to be taken with certain restrictions.'
Researchers found the risk of death increased with the number of prescriptions for beta-agonists active in the 30 days prior to dying.
One active dispensation of a short-acting beta-agonist increased all-cause mortality 2.8-fold and two or more 4.1-fold. For long-acting beta-agonists, risk increased 1.3-fold and 2.2-fold respectively.
The risk of sudden or cardiac death was increased particularly sharply in users of beta-agonists, which the researchers said implied the association was causal.
Two or more active prescriptions of short-acting beta- agonists increased risk 7.0-fold and long-acting beta-agonists 4.3-fold.
Dr Kevin Gruffydd-Jones, a GP in Box, Wiltshire, and education lead for the General Practice Airways Group, said: 'This is new information. It does raise concerns. Traditionally these have been very safe drugs to use and they have been used extensively. Maybe we need to look at the effects of using high-dose beta-agonists of any sort.'
Dr David Bellamy, member of the NICE guidelines committee on COPD and a GP in Bournemouth, said the results were 'slightly concerning' as the drugs were so widely used, but that it would take 'pretty strong, hard evidence' to change practice.
The study, which analysed records from 9,545 COPD patients over 66 who had died and 9,545 matched controls, was presented at the International Society for Pharmacoepidemiology conference in Nashville, US, last month.
By Daniel Cressey