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Beta agonists, inhaled steroids, and the risk of intensive care unit admission for asthma

¹ Division of Pulmonary and Critical Care Medicine, ² Cardiovascular Research Institute, ³ Division of Research Northern California Kaiser Permanente, ⁴ Division of Occupational and Environmental Medicine, Dept of Medicine, University of California, San Francisco and ⁵ Dept of Allergy, Kaiser Permanente, Vacaville, CA, USA

CORRESPONDENCE: M.D. Eisner, University of California, San Francisco, 350 Parnassus Avenue, Ste 609, San Francisco, CA 94117, USA. Fax: 1 4154766426

Keywords: adrenergic beta agonists, anti-inflammatory agents, asthma, drug therapy, epidemiology, mortality, steroidal

Received: April 14, 2000
Accepted September 5, 2000

Supported by National Research Service Award F32 HL0054 and K23 HL04201 and K04 HL03225, National Heart, Lung, and Blood Institute, National Institutes of Health.

Although inhaled corticosteroid (ICS) use is associated with a decreased risk of hospitalization for asthma, the impact of ICS on the risk of life-threatening asthma exacerbation is less clear. The effect of ICS and inhaled beta agonist (IBA) dispensing on the risk of intensive care unit admission for asthma, a surrogate for life-threatening exacerbation, is evaluated.

Using computerized International classification of diseases (ICD)-9 discharge diagnoses, a cohort of all 2,344 adult Northern California members of a health maintenance organization hospitalized for asthma over a 2-yr period were identified. Computerized pharmacy data was used to ascertain asthma medications dispensed during the 3-, 6-, and 12-month intervals preceding index hospitalization for asthma.

During the 3-months preceding hospitalization, a minority of subjects had no IBA units dispensed (34%), with 14% receiving low level (1 unit), 20% medium level (2–3 units), and 32% high level (4 units) therapy. A substantial proportion received no ICS units (55%), whereas 13% had low, 16% medium, and 15% high level therapy. In multiple logistic regression analysis, high level IBA use was associated with a greater risk of intensive care unit (ICU) admission for asthma after controlling for asthma severity. There was no relationship, however, between low or medium level IBA use and ICU admission. Conversely, medium level and high level ICS use were associated with a reduced risk of ICU admission. Analysing 6- and 12-month medication dispensing data, similar risk patterns were observed.

Inhaled corticosteroid dispensing was associated with reduced risk of intensive care unit admission among adults hospitalized for asthma, whereas the opposite applied for high dose beta agonist usage. This suggests that ICS prescription to adults with moderate-to-severe asthma could reduce the risk of life-threatening exacerbation.

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