Low Dose Inhaled Corticosteroid in Asthma & Prevention of Acute Coronary Syndrome

Hameed Al-Qaseer, Abdul

	Low Dose Inhaled Corticosteroid in Asthma & Prevention of Acute Coronary Syndrome
Mustansiriya Medical Journal
Article 1, Volume 9, Issue 1, 2010, Pages 57-62
Author
Abdul Hameed Al-Qaseer
Abstract
Background Asthma is associated with higher risk of adverse cardiovascular outcomes. Hypoxemia and inflammation had been suggested to play a role and the use of inhaled corticosteroids is possibly associated with a major effect on reduction this higher risk with amelioration of the suggested mechanisms. Objective This study had been designed to assess the effect of the use of low dose inhaled corticosteroids on the frequency of myocardial infarction in asthmatic patients, compared to the effect of other anti-asthmatic medications. Methods This study is a prospective study that included 92 asthmatic patients who had unstable angina at the time of inclusion. The sample were randomly selected from those who had been admitted to the coronary care unit of Al-Yarmouk Teaching Hospital during the period between February 2008 to February 2009, with the mean period of follow up of 8.3± 2.1 months (6 months-1 year). Detailed medical history had been taken and thorough physical examination was made for all patients. The patients had been sub-classified according to the type of the used therapy for asthma. Results Twenty three male and 69 female patients had been enrolled in this study. The mean age was 52.48 ± 9.86 and 50.36 ± 6.8 year-old for male and female patients, respectively. After 1 year of follow up 17 patients (18.5% of the sample) had myocardial infarction during the period of follow up, the rest of the sample (75 patients, 81.5% of the sample) completed their period of follow up without any evidence of having myocardial infarction. Sixty patients had been treated with inhaled corticosteroid therapy (65.2%), while 20 patients (21.7%) and 12 patients (13%) had been treated with inhaled B2 agonist therapy alone and inhaled B2 therapy in addition to leukotrien receptor antagonist therapy, respectively. Nine out of the 17 patients (52.9% of those with MI) were 40-49 year-old. Only 5 out of the 60 patients who had been treated with inhaled corticosteroid therapy (29.4% of those having MI, 8.3% of those treated with inhaled corticosteroid therapy) had myocardial infarction during their follow up. This study revealed that 5 out of 17 patients with evidence of acquiring myocardial infarction during the period of follow up (29.4%) had at least one marker of asthma severity. Only 2 out of 18 patients with any marker of asthma severity had used low dose inhaled corticosteroid (11.1%), while the rest of them (16 patients, 88.9% of those with any marker of severity) were using other anti-asthmatic medications. Conclusion The use Low dose inhaled corticosteroid was associated with decreased frequency of acute myocardial infarction in asthmatic patients initially diagnosed to have unstable angina in comparison to the frequency of MI among patients treated with other anti-asthmatic medications. MI was more frequent among younger asthmatic patients. Having any marker of asthma severity is associated with higher risk of having myocardial infarction. Having any marker of asthma severity is associated with higher risk of having myocardial infarction. Use of low dose inhaled corticosteroid is associated with less severe asthma and lower frequency of developing acute myocardial infarction.
Keywords
inhaled; corticosteroids; asthma; myocardial; infarction; prevention

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