In a recent study published in BMC Pulmonary Medicine journal entitled “Reliever salbutamol use as a measure of exacerbation risk in chronic obstructive pulmonary disease,” researchers from the University of Sydney, in collaboration with The George Institute for Global Health, suggest that short/long-term use of the drug salbutamol 90 μg accelerates exacerbation of chronic obstructive pulmonary disease (COPD).
Chronic obstructive pulmonary disease is a common lung illness characterized by poor airflow through the lungs. Patients with COPD suffer from cough, sputum production, and shortness of breath. The disease typically worsens over time and may lead to more serious symptoms like high blood pressure in the lung arteries, leg swelling and bulging neck veins. COPD has no known cure, but various treatments are available to limit its progression such as lifestyle changes, oxygen therapy, and inhaled medications like β2 agonists. Various factors have been reported to cause COPD including tobacco smoking, air pollution, dusts, chemicals, fumes, genetic risk factors as well as some medical conditions like HIV/AIDS, tuberculosis, pneumonia and asthma.
Sometimes, a sudden worsening of symptoms called an “acute exacerbation” may occur in patients with COPD. This is commonly triggered by bacteria/viruses or by environmental pollutants like exposure to tobacco smoke and changes in temperature from warm to cold. However, improper use of medications can also cause exacerbation of COPD. With this in mind, a team of researchers from Australia conducted a study to see if the muscle-smoothing beta 2-agonist salbutamol 90 μg triggers short/long term risks of COPD exacerbation.
In the study, a total of 810 patients with moderate to very severe COPD were included, of which 61% were males with average age of 63.2 years. The researchers compared the medications budesonide/formoterol 320/9 μg and formoterol 9 μg administrated twice daily along with the reliever salbutamol 90 μg. For the study’s short-term 3-week evaluation, the patients were subjected to 4, 10, and 20 inhalations per day, ranked in the study as low, medium and high respectively. For long-term risk assessment measured at the study’s 10-month mark, the patients were given the reliever 2 to 5, 6 to 9, and more than 10 inhalations per day. The results indicated that exacerbation risk increased substantially with the reliever use over a 3-week period.
Specifically, 692 patients attained the low threshold of reliever utilization, 351 patients reached the medium threshold and 91 patients attained the high threshold. For long term assessment, exacerbation risk was also observed to increase as the number of inhalations per day increases. The data indicated that patients with high use of the reliever had a 135% increased exacerbation rate compared to 67% for medium use and 21% for low use of the reliever. Additionally, budesonide/formoterol is found to induce lower short/long-term exacerbation risk if compared to formoterol in all reliever-use groups.
In conclusion, it is clear that the β2-agonist salbutamol reliever triggers short and long-term exacerbation risk in patients suffering from COPD receiving budesonide/formoterol or formoterol drugs. In the future, the researchers plan additional clinical trials and effectiveness evaluation of COPD patients with different disease severity and exacerbation history.