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Observational Study
. 2024 Dec 11:8:e56848.
doi: 10.2196/56848.

The Effect of Inhaled Beta-2 Agonists on Heart Rate in Patients With Asthma: Sensor-Based Observational Study

Rishi Jayant Khusial  1 , Jacob K Sont  1 , Omar S Usmani  2 , Matteo Bonini  2   3 , Kian Fan Chung  2 , Stephen James Fowler  4 , Persijn J Honkoop  1
Affiliations
Observational Study

The Effect of Inhaled Beta-2 Agonists on Heart Rate in Patients With Asthma: Sensor-Based Observational Study

Rishi Jayant Khusial et al. JMIR Cardio. .

Abstract

Background: Beta-2 agonists play an important role in the management of asthma. Inhaled long-acting beta-2 agonists (LABAs) and short-acting beta-2 agonists (SABAs) cause bronchodilation by stimulating adrenoceptors. These receptors are also present in cardiac cells and, as a side effect, could also be stimulated by inhaled beta-2 agonists.

Objective: This study aims to assess the effect of beta-2 agonists on heart rate (HR).

Methods: The data were retrieved from an observational study, the myAirCoach Quantification Campaign. Beta-2 agonist use was registered by self-reported monthly questionnaires and by smart inhalers. HR was monitored continuously with the Fitbit Charge HR tracker (Fitbit Inc). Patients (aged 18 years and older) were recruited if they had uncontrolled asthma and used inhalation medication. Our primary outcome was the difference in HR between LABA and non-LABA users. Secondary outcomes were the difference in HR on days SABAs were used compared to days SABAs were not used and an assessment of the timing of inhaler use during the day.

Results: Patients using LABA did not have a clinically relevant higher HR (average 0.8 beats per minute difference) during the day. Around the moment of SABA inhalation itself, the HR does increase steeply, and it takes 138 minutes before it returns to the normal range.

Conclusions: This study indicates that LABAs do not have a clinically relevant effect on HR. SABAs are instead associated with a short-term HR increase.

Trial registration: ClinicalTrials.gov NCT02774772; https://clinicaltrials.gov/study/NCT02774772.

Keywords: Fitbit; asthma; asthma management; beta-2 agonists; cardiac cells; heart rate; inhaler; inhaler medication; mHealth; monitoring; observational study; sensor; side effects.

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Conflict of interest statement

Conflicts of Interest: OSU reports personal fees from Astra Zeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma, Sandoz, Takeda, Cipla, Covis, Novartis, Orion, Menarini, UCB, Trudell Medical, Deva, and Kamada. OSU reports consulting fees from Astra Zeneca, Cipla, and Mereo Biopharma. He reports grants from Astra Zeneca, Boehringer Ingelheim, Chiesi, and GlaxoSmithKline.

MB reports personal fees for attending Advisory Board meetings and giving lectures from AZ, Chiesi, Grifols, GSK, Lusofarmaco, Menarini, Omron, and Sanofi.

KFC reports personal fees from attending Advisory Board meetings with GSK, AZ, Novartis, Roche, Merck, Trevi, Rickett-Beckinson, Nocion, and Shionogi. He is a scientific adviser to The Clean Breathing Institute supported by Haleon. He reports personal fees for speaking at meetings supported by GSK, Sanofi, Novartis, and AZ. He, through his institution, has received research funding from Merck & GSK.

JS has received payments for registry ICT infrastructure from the RAPSODI Foundation and the ERS SHARP CRC, as well as an institutional research grant from AstraZeneca.

Other authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Self-reported LABA use and heart rate throughout the day. The time on the x-axis is clock hours. Heart rate during follow-up with and without LABA use follows a normal circadian rhythm. The mean heart rate per patient per hour was calculated first. Next, the mean score is calculated by LABA follow-up. This is done so the number of measurements per patient would not influence results. LABA: long-acting beta-2 agonist.
Figure 2
Figure 2
Inhalations. The number of inhalations is recorded with the smart inhaler. Patients used smart inhalers for their inhaled medication in their treatment as usual. The number of inhalations can therefore not be compared to each other. Patients used their maintenance medication (ICS or ICS/LABA) twice daily and their rescue inhalation during the day equally, except for a minor peak between 8 AM and 9 AM. ICS: inhaled corticosteroid; LABA: long-acting beta-2 agonist; SABA: short-acting beta-2 agonist.
Figure 3
Figure 3
HR around LABA use as measured with the smart inhaler. HR: heart rate; LABA: long-acting beta-2 agonist.
Figure 4
Figure 4
Steps taken around SABA inhalation. SABA: short-acting beta-2 agonist.
Figure 5
Figure 5
SABA inhalation registered with the smart inhaler and HR. HR: heart rate; SABA: short-acting beta-2 agonist.
See this image and copyright information in PMC

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