Education And Debate

Controversies in Management: Still cause for concern

BMJ 1994; 309 doi: (Published 24 September 1994) Cite this as: BMJ 1994;309:794
  1. A E Tattersfield
  1. Division of Respiratory Medicine, City Hospital, Nottingham NG5 1PB.

    Use of ß2 agonists in asthma: much ado about nothing?

    The evidence that ß2 agonists can have adverse effects comes from mortality and morbidity studies. An epidemic of deaths from asthma occurred in the 1960s in countries, including the United Kingdom, where a high dose of preparation of isoprenaline was available. Mortality fell after the resultant publicity and withdrawal of the over the counter preparation in Britain.1 A second epidemic occurred in New Zealand in the 1970s after the introduction of fenoterol. The drug rapidly achieved a high market share and was again marketed at a high dose2; it may also be less ß2 selective. A series of case-control studies showed that patients who had died from asthma were more likely to have been receiving fenoterol than other ß agonists.3 although these studies have been criticised because of the difficulty of matching cases and controls in retrospective studies.

    Nevertheless, there have been two epidemics of asthma deaths in the past 40 years, both have been associated with use of a high dose …

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