The Role of Beta Receptor Agonist Therapy in Asthma Mortality PDF
Preview The Role of Beta Receptor Agonist Therapy in Asthma Mortality
THE ROLE of BETA RECEPTOR AGONIST THERAPY in ASTHMA MORTALITY Taylor & Francis Taylor & Francis Group http:// taylorandfrancis.com THE ROLE of BETA RECEPTOR AGONIST THERAPY • ln ASTHMA MORTALITY Edited by Richard Beasley Neil E. Pearce Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 Reissued 2019 by CRC Press © 1993 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. 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CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. A Library of Congress record exists under LC control number: Publisher's Note The publisher has gone to great lengths to ensure the quality of this reprint but points out that some imperfections in the original copies may be apparent. Disclaimer The publisher has made every effort to trace copyright holders and welcomes correspondence from those they have been unable to contact. ISBN 13: 978-0-367-23661-8 (hbk) ISBN 13: 978-0-429-28108-2 (ebk) Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com FOREWORD I feel honoured to have been invited to introduce this excellent monograph which surveys and analyzes the nature, actions, and unwanted actions of one of the most widely used class of drugs in respiratory medicine — the beta agonists. Until recently there were few reasons to question their basic safety; after all their actions are only part of the wider actions of adrenaline. Further, following the introduction of corticosteroids and cromoglycate, the emphasis on reversible airflow obstruction as the essence of asthma was overtaken by the concept of bronchial inflammation. Indeed, deaths from asthma are fre- quently attributed to inadequate use of corticosteroids, and protocols of therapy have been based on this assumption. The introduction of the new, powerful, beta2 agonist, fenoterol, together with the relatively high (though still low) death rate from asthma in New Zealand, led to revival of suspicion that these drugs might be responsible. The problems of investigating such a suspicion were formidable: a disorder with no agreed operational definition, high prevalence, and a wide range of severity; a drug with few side effects other than the suspicion of a very low incidence of death; the usual treatment regimen included self-administration; there was often poor documentation of the events preceding the death. Further, confirmation of these suspicions would have implications not only for the treatment of this common disorder, but for the drug regulatory authorities and the pharmaceutical industry itself. This monograph examines rigorously the many facets of this problem, including the pharmacology of beta agonists, their clinical usage, epidemi- ological aspects of asthma and its treatment, and epidemiological method- ology. While an immediate contribution will be to the clinical management of asthma, on which it is likely to have a profound effect, its ultimate influence will be far wider. By addressing a situation that has many parallels in medicine, it has contributed to their better understanding and their solution. As Popper has made clear, nothing in science is capable of proof, only disproof. Beasley, Pearce, and colleagues have marshalled the evidence to incriminate fenoterol in the increased death rate from asthma in New Zealand in the 1970s, as well as reviewing evidence linking another beta agonist (isoprenaline forte) to the epidemics of the 1960s, and raising more general questions about the efficacy and safety of this class of drug. The burden now lies with those who would disprove this hypothesis. Unless or until this happens, no longer will clinicians be able to prescribe these drugs as if their only effect is their undoubted symptomatic benefit. The editors and contributors, in tackling a specific problem, have illu- minated a much wider area of medicine from which the full benefits are yet to be derived. They have earned our congratulations and our thanks. J. B. Howell Emeritus Professor of Medicine Taylor & Francis Taylor & Francis Group http:// taylorandfrancis.com PREFACE Asthma is one of the few treatable diseases in which there has been a widespread increase in reported morbidity and mortality over recent decades. These adverse trends have occurred despite major increases in our knowledge and understanding of the pathophysiology of the disease, improved diagnostic awareness, and the availability of more potent and specific forms of therapy. In this context, it is important to consider whether some aspects of our current management may be adversely affecting the natural history of the disease. In this book, the possible role of beta-agonist therapy in asthma mortality is critically reviewed. An attempt has been made to produce a comprehensive overview of existing knowledge, bringing together relevant information that has been published in many different journals, covering a wide range of disciplines. This multidisciplinary approach spans the fields of epidemiology, pharmacology, clinical medicine, and public health. It includes an historical perspective and sections on experimental and epidemiological methods for examining .the possible relationship between beta-agonist therapy and asthma mortality. The authors of the chapters in this book are internationally rec- ognized experts in their fields, and have all made major contributions to our understanding of these issues. Although this has been a controversial area, it is pleasing that the con- troversy has led to further research, the results of which have improved our understanding of beta-agonist therapy, and the way in which it should be used in the management of asthma. However, as highlighted in this book, there are still many unanswered questions that will need to be resolved through further research. It is always difficult to decide when it is the right time to prepare such a book. However, we felt that it was important that existing scientific evidence is reviewed at this stage, in this rapidly expanding field. Unfortunately, a review of the possible role of the many nonpharmacological factors that may have contributed to the increase in prevalence, morbidity, and mortality from asthma was beyond the scope of this book. Likewise, recommendations for the therapeutic use of beta-agonist drug treatment are not addressed in this book, but they are well covered in many other texts on asthma. We hope that this book will be of interest to clinicians, pharmacologists, epidemiologists, and all those interested in addressing the problems of in- creasing asthma morbidity and mortality. Richard Beasley, M.D. Neil Pearce, Ph.D. THE EDITORS Richard Beasley, M.D., is Professor of Medicine at the Wellington School of Medicine, University of Otago Medical School and Consultant Physician at Wellington Hospital, Wellington, New Zealand. Dr. Beasley graduated in 1979 from the University of Otago Medical School with an MBChB degree and became a fellow of the Royal Australasian College of Physicians in 1985. He then took up a New Zealand Medical Research Council-Wellcome Trust Research Fellowship at the University of Southampton, United Kingdom, before returning to the Wellington School of Medicine in 1987 and was appointed to the Chair of Medicine in 1993. He was awarded his M.D. degree from the University of Southampton in 1990, and returned to that institution as a Medical Research Council (U.K.) Visiting Senior Scientist in 1992. Dr. Beasley is a member of the American Thoracic Society, British Tho- racic Society, European Respiratory Society, Thoracic Society of Australia and New Zealand, and the Collegium Internationale Allergologicum. He is President of the Australian Chapter of the International Association of Asth- mology and has served on a number of advisory committees including the Expert Panel of the FDA Pulmonary-Allergy Drugs Advisory Committee. Dr. Beasley is author of more than one hundred papers in the medical literature. His current major research interests in the field of asthma are related to epidemiology, pharmacology, and management. Neil Pearce, Ph.D,, is a Senior Research Fellow in the Department of Medicine in the Wellington School of Medicine. Dr. Pearce obtained his training at the Wellingtoi School of Medicine, completing his Ph.D. degree in epidemiology in 1985 From 1985 to 1987 he carried out epidemiological research in the Departim nt of Epidemiology, University of North Carolina at Chapel Hill, funded by an Overseas Research Fellowship of the Health Research Council of New Zealand. Since 1987 he has primarily carried out teaching and research in epide- miology at the Wellington School of Medicine, but during 1992 to 1993 he is based at the International Agency for Research on Cancer in Lyon, France, was recipient of a Visiting Scientist Award. He is currently engaged in full- time epidemiological research in the Wellington School of Medicine with funding from the Health Research Council of New Zealand; his asthma epidemiology research is conducted as a member of the Wellington Asthma Research Group (directed by Drs. Beasley, Burgess, Crane, and Pearce), which is funded by a Programme Grant from the Health Research Council of New Zealand. Dr. Pearce is a member of the Australasian Epidemiology Association, the International Epidemiology Association, the International Society for Pharmacoepidemiology, the Society for Epidemiologic Research, and the Thoracic Society of Australia and New Zealand. Dr. Pearce has co-authored a textbook of occupational epidemiology, and more than one hundred papers. His current major research interests include asthma epidemiology, occupa- tional and environmental epidemiology, cancer epidemiology, and epidemi- ological methods.
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