β-Adrenergic bronchodilators and sudden death in asthmatics

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Abstract
Deaths from asthma greatly increased in Britain between 1961 and 1967. Over the same period the use of pressurised aerosols containing β-stimulants (usually isoprenaline) also increased greatly and it was suggested that the use of such aerosols contributed to the increase in mortality.1 2 Then in 1967 the Committee on Safety of Drugs issued a warning notice and in 1968 the supply of aerosols, previously available over the counter, was restricted to prescription only. From 1967 the death rate fell rapidly, although the use of β-stimulant aerosols showed only a modest decrease.3 This decline in mortality began to occur before the widespread use of bronchodilator aerosols such as isoetharine, salbutamol and terbutaline, which are relatively selective for the β-adrenoceptors of the lungs, before the development of aerosols of locally active corticosteroids, and before disodium cromoglycate was widely used. Moreover in younger patients mortality is still a little higher than it was before the epidemic.

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