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Haemodynamic responses to salbutamol and isometric exercise are altered in young adults with mild asthma

  • Pharmacodynamics
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Abstract

Objectives: Tolerance to the haemodynamic effects of regularly inhaled β2 agonists has been reported in a research setting. It is unclear whether cardiovascular responses in adults with asthma are influenced by their use in routine clinical practice. This study aimed to characterise the effects of acute salbutamol administration on systemic haemodynamics in adults with mild asthma who were receiving intermittent β2 agonist treatment. Methods: Ten patients with mild asthma and ten healthy age and sex-matched controls were recruited to a randomised placebo-controlled double-blind two-way crossover study. Each received salbutamol 200 μg or placebo, then performed sustained isometric handgrip exercise as an adrenergic cardiovascular stimulus. Heart rate and blood pressure responses were observed during rest and exercise, and cardiac index and systemic vascular resistance index were measured using non-invasive impedance cardiography. Results: Isometric exercise caused a greater increase in heart rate (12±3 vs. 8±3 bpm, P<0.01) and diastolic blood pressure (19±3 vs. 12±3 mmHg, P<0.01) in patients with asthma compared with healthy controls. Salbutamol administration significantly increased heart rate, blood pressure and cardiac index in healthy controls, but these responses were attenuated in patients with asthma. Conclusion: These findings indicate that adults with asthma, who are receiving intermittent β2 agonist treatment, have a greater cardiovascular responses to sympathetic stimulation, and haemodynamic tolerance to acute salbutamol administration.

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References

  1. Lanes SF, Garcia-Rodriguez LA, Huerta C (2002) Respiratory medications and risk of asthma death. Thorax 57:683–686

    Article  Google Scholar 

  2. Sears MR (2001) Short-acting beta-agonist research: a perspective 1997. Can Respir J 8:349–355

    Google Scholar 

  3. Beasley R, Pearce N, Crane J, Burgess C (1999) Beta-agonists: what is the evidence that their use increases the risk of asthma morbidity and mortality? J Allergy Clin Immunol 103:S18–S30

    Google Scholar 

  4. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE (1990) Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma. Lancet 336:1396–1399

    Article  Google Scholar 

  5. Hall JA, Petch MC, Brown MJ (1989) Intracoronary injections of salbutamol demonstrate the presence of functional beta-2 adrenoceptors in the human heart. Circ Res 65:546–553

    Google Scholar 

  6. Langer SZ (1980) Presynaptic regulation of the release of catecholamines. Pharmacol Rev 32:337–362

    Google Scholar 

  7. Mäki T, Kontula K, Härkönen M (1990) The beta-adrenergic system in man: physiological and pathophysiological response regulation of receptor density and function. Scand J Clin Lab Invest 50(Suppl 201):25–43

    Google Scholar 

  8. Stein CM, Nelson R, Deegan R, He H, Wood M, Wood AJJ (1995) Forearm beta adrenergic receptor-mediated vasodilatation is impaired, without alteration of forearm norepinephrine spillover, in borderline hypertension. J Clin Invest 96:579–585

    Google Scholar 

  9. Jartti TT, Kaila TJ, Yahvanainen KUO, Kuusela TA, Vanto TT, Valimaki IAT (1998) Altered cardiovascular autonomic regulation after salmeterol treatment in asthmatic children. Clin Physiol 18:345–353

    Article  Google Scholar 

  10. Jartti TT, Kaila TT, Tahvanainen KUO, Kuusela TA, Vanto TT, Valimaki IAT (1997) Altered cardiovascular autonomic regulation after 2-week inhaled salbutamol treatment in asthmatic children. Eur J Pediatr 157:883–888

    Google Scholar 

  11. Grove A, Lipworth BJ (1995) Tolerance with the beta 2-adrenoceptor agonists: time for reappraisal. Br J Clin Pharmacol 39:109–118

    Google Scholar 

  12. Chapman KR, Smith DL, Rebuck AS, Leenen FH (1984) Hemodynamic effects of an inhaled beta-2 agonist. Clin Pharmacol Ther 35:762–767

    Google Scholar 

  13. Ewing DJ, Irving JB, Kerr F, Wildsmith JA, Clarke BF (1974) Cardiovascular responses to sustained handgrip in normal subjects and in patients with diabetes mellitus: a test of autonomic function. Clin Sci Mol Med 46:295–306

    Google Scholar 

  14. Waring WS, Chui M, Japp A, Nicol EF, Ford MJ (2004) Autonomic cardiovascular responses are impaired in women with irritable bowel syndrome. J Clin Gastroenterol 38:658–663

    Google Scholar 

  15. Silke B, McAuley D (1998) Accuracy and precision of blood pressure determination with the Finapres: an overview using re-sampling statistics. J Hum Hypertens 12:403–409

    Article  Google Scholar 

  16. Thomas SH (1992) Impedance cardiography using the Sramek-Bernstein method: accuracy and variability at rest and during exercise. Br J Clin Pharmacol 34:467–476

    Google Scholar 

  17. Badr C, Elkins MR, Ellis ER (2002) The effect of body position on maximal expiratory pressure and flow. Aust J Physiother 48:95–102

    Google Scholar 

  18. Calhoun WJ, Sutton LB, Emmett A, Dorinsky PM (2003) Asthma variability in patients previously treated with beta2-agonists alone. J Allergy Clin Immunol 112:1088–1094

    Article  Google Scholar 

  19. Fontana GA, Pantaleo T, Federico L, Bongianni F, Mannelli M, Bridge PD, Pistolesi M (2002) Handgrip-induced airway dilation in asthmatic patients with bronchoconstriction induced by MCh inhalation. J Appl Physiol 93:1723–1730

    Google Scholar 

  20. Jartti TT, Kuusela TA, Kaila TJ, Tahvanainen KUO, Valimaki AT (1998) The dose-response effects of terbutaline on the variability, approximate entropy and fractal dimension of heart rate and blood pressure. Br J Clin Pharmacol 45:277–285

    Article  Google Scholar 

  21. Amadi A, Ponikowski P, Coats AJ (1995) Role of catecholamines and sympathetic activation as a risk factor for coronary artery disease. J Cardiovasc Risk 2:222–228

    Google Scholar 

  22. Hanratty CG, Silke B, Riddell JG (1999) Evaluation of the effect on heart rate variability of a beta 2-adrenoceptor agonist and antagonist using non-linear scatterplot and sequence methods. Br J Clin Pharmacol 47:157–166

    Article  Google Scholar 

  23. Benovic JL (2002) Novel beta 2-adrenergic receptor signalling pathways. J Allergy Clin Immunol 110:S229–S235

    Article  Google Scholar 

  24. Qing F, Rahman SU, Hayes MJ, Rhodes CG, Ind PW, Jones T, Hughes JM (1997) Effect of long-term beta 2-agonist dosing on human cardiac adrenoceptor expression in vivo: comparison with changes in lung and mononuclear leukocyte beta-receptors. J Nucl Cardiol 4:532–538

    Article  CAS  PubMed  Google Scholar 

  25. Larsson K (1985) Studies of sympatho-adrenal reactivity and adrenoceptor function in bronchial asthma. Eur J Respir Dis Suppl 141:1–52

    Google Scholar 

  26. Grove A, McFarlane LC, Lipworth BJ (1995) Expression of the beta 2 adrenoceptor partial agonist/antagonist activity of salbutamol in states of low and high adrenergic tone. Thorax 50:134–138

    Google Scholar 

  27. Anderson PJ, Zhou X, Breen P, Gann L, Logsdon TW, Compadre CM, Hiller FC (1998) Pharmacokinetics of (R,S)-Albuterol after aerosol inhalation in healthy adult volunteers. J Pharm Sci 87:841–844

    Article  Google Scholar 

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Correspondence to W Stephen Waring.

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Waring, W.S., Leigh, R.B. Haemodynamic responses to salbutamol and isometric exercise are altered in young adults with mild asthma. Eur J Clin Pharmacol 61, 9–14 (2005). https://doi.org/10.1007/s00228-004-0880-7

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  • DOI: https://doi.org/10.1007/s00228-004-0880-7

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