Comparison of side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease

Comparison of side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease Muhammad Najeeb, Housam AlBardan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4305151/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Excessive use of short-acting inhaled bronchodilators indicates poor asthma control and adverse health outcomes. The research aims to study the side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease. Study design: Retrospective, cross-sectional observational study, location. Study: Patients admitted to the Internal Thoracic Division, Damascus Hospital (Al-Mujtahid Hospital), in Damascus, Syria. Duration of the study: 4 years between 2020 and 2024. Inclusion criteria: All patients with asthma and obstructive pulmonary disease admitted to the Internal Thoracic Division, Damascus Hospital (Al-Mujtahid Hospital) whose ages range from 18 to 80 years. Exclusion criteria: Patients with other chronic lung diseases (cancers, tuberculosis), patients taking long-acting bronchodilators, patients taking systemic bronchodilators, patients with cachexia. Data analysis was performed using SPSS-28 software. Results: Patients’ ages ranged from 18 to 18 years. -80 years, and the most common age group is 60-80 years, and 61% of patients are male. Headaches, nervous tension, lack of appetite, pharyngeal pain, stomach pain, and muscle spasms were most common among patients treated with short-acting beta-2 analogues, with rates of 82.6% and 75%. 66.6%, 82.6%, and 80%, respectively, while hand tremors, allergic reaction, vomiting, runny nose, agitation, and contractile convulsions were more common in patients treated with short-acting antimuscarinics, with rates of 100%, 66.7%, 100%, 100%, 100%, 100%, respectively. Conclusion: The use of short-acting bronchodilators was accompanied by a group of side effects, as headache and pharyngeal pain were common in all types, while stomach pain, muscle spasms, nervous tension, and lack of appetite were common in those who used to short-act beta agonists, and allergic reaction, hand tremors, and vomiting. Rhinorrhea, irritability, and constriction were more common among patients using short-acting antimuscarinics, and the occurrence of symptoms was associated with increasing dose and duration of use. Pulmonology side effects short-acting bronchodilators asthma obstructive pulmonary disease Introduction Asthma is known as a chronic inflammatory disease in the airways in which many inflammatory cells accumulate, especially mast cells, eosinophils, lymphocytes, and others. This accumulation leads to inflammation in the walls of the bronchial tubes, which edemas and spasms them and stimulates an increase in the secretion of sticky phlegm in them, which narrows, causing shortness of breath, coughing, and wheezing. wheezing, and these symptoms recur at night and when exposed to certain allergens that trigger this inflammatory process. Drug treatment for acute and severe asthma attacks includes giving oxygen, bronchodilators, and corticosteroids ( 1 ) Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstruction of the flow of air out of the lungs. This disease is sometimes called emphysema or chronic bronchitis. Its symptoms include difficulty breathing, coughing, phlegm formation, and wheezing, and its infection usually occurs due to prolonged exposure. Irritating gases or particles, often emitted from cigarette smoke, and people with it are more susceptible to heart disease, lung cancer, depression, and high blood pressure in the lung arteries. Bronchodilator inhalers are the most important medications for treating chronic obstructive pulmonary disease and helping the airways relax. To keep it open, oxygen, steroids, and antibiotics may also be used to treat sudden attacks ( 2 ) Bronchodilators are widely used to treat acute asthma and chronic obstructive pulmonary disease, which include β2 agonists, muscarinic receptor antagonists, and xanthin compounds. It is preferable to use the inhaled route rather than the systemic route to reduce harmful side effects. It is also preferable to use rapid and short-acting agents to treat the acute attack and the symptoms accompanying asthma. and COPD ( 3 ) Materials and methods Importance of studying: Overuse of short-acting bronchodilators indicates poor asthma control and adverse health outcomes. Contemporary population data on use, risk factors and the impact of short-acting bronchodilator use on asthma exacerbations and deaths are rare, prompting the initiation of the global SABINA (Use of Short-Acting Bronchodilators in... Asthma and obstructive pulmonary disease). Objectives of the study: Main objective: Study of the side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease. Secondary Objective: Developing an educational and treatment plan for doctors dealing with patients with asthma and obstructive pulmonary disease, and their families, which improves the management of these diseases, prevents their occurrence, and also reduces the occurrence of side effects of short-acting inhalation bronchodilators resulting from excessive use. Patient sample and study methods: Study design: A retrospective, cross-sectional observational study. Place of study: Patients admitted to the Internal Thoracic Division, Damascus Hospital (Al-Mujtahid Hospital), in Damascus, Syria. Duration of study: 4 years between 2020 and 2024. Inclusion criteria in the study: All patients with asthma and obstructive pulmonary disease admitted to the Internal Thoracic Department, Damascus Hospital (Al-Mujtahid Hospital), aged (18 to 80 years). Exclusion criteria for the study: 1. Patients who have other chronic lung diseases (cancers, tuberculosis). 2. Patients taking long-acting bronchodilators. 3. Patients taking systemic bronchodilators. 4. Convulsive patients. Data collection: Data were collected from patient files, and patients with asthma and obstructive pulmonary disease were taken within the target age group admitted to the Internal Chest Division, Damascus Hospital (Al-Mujtahid Hospital), after obtaining informed approval from the Scientific Research Ethics Committee at the Syrian Private University, and from the Director of Damascus Hospital for admission to the hospital. Archive patients to collect samples. A detailed clinical history was taken from the patients' files, and the results of the clinical examination and results of monitoring vital signs were taken. Information was also taken about the laboratory tests performed by the patients, and the necessary radiological investigations. Statistical analysis methods used: Descriptive statistics: frequencies and percentages for qualitative variables, measures of central tendency, and measures of dispersion such as standard deviation for quantitative variables, bar and pie charts to express frequencies and percentages. Inferential statistics: Chi square test to compare nominal variables, Kolmogrov-Smirnov test to determine the normal distribution of the data, Independent Sample T test to compare continuous variables, we used Kaplan-Meier analysis to compare differences in survival between the studied groups, while using the Log Ran test to determine the statistical value. For these differences, a multivariate analysis was performed according to the Cox regression method to identify variables with future predictive value. The IBM SPSS version 28 statistical package program was used to analyze the data, and the results were considered statistically significant with a P-value Ethical considerations: Ethical approval was obtained from the Institutional Review Board (IRB) Faculty of Medicine, Syrian Private University and director of Damascus Hospital. Results The ages of patients in our study ranged from 18 to 80 years, and the most common age group was 60 to 80 years, at 53%, followed by the age group from 40 to 59 years, at 28%. As for the age group, 18 to 39 years, the lowest percentage was 19%, the male/female ratio. : 61%/39%, most of the patients were retirees and employees (35%, 32%, respectively), while the percentage of workers and students was 20%, 13%, respectively. The percentage of smokers in our study was 51%, the percentage of smokers was more than one packet per day. It is the most common at 63.7%, and the rate of smoking for more than 10 years is the most common at 49.1%. In our study, we found that the rate of presence of chronic obstructive pulmonary disease is 61%, while the rate of presence of asthma is 39%. The most common medical history among the research patients was high arterial pressure at a rate of 22%. It was followed by type 2 diabetes at a rate of 18%, followed by cardiovascular diseases at a rate of 17%, the percentage of asthma was 10%, and COPD was 9%. The most common heart disease among the research patients was myocardial infarction at a rate of 10%, followed by heart failure at 4%, and the percentages of each of them were Stable and unstable angina and atrial fibrillation were 1% for each. The rate of familial asthma was 24%, the rate of use of short-acting beta-2 agonists was 80%, the rate of use of short-acting antimuscarinics was 20%, and the rate of use of both was 4%. The average The number of sprays used per week was 5.22 sprays, with a standard deviation of 1.8 sprays, and the average years of using bronchodilators was 7.08 years, with a standard deviation of 1.78 years. The average dose prescribed to the patient was 2.26 mg, with a standard deviation of 0.97 mg. Speaking of the side effects resulting from the use of short-acting bronchodilators, we found that headaches and nervous tension Decreased appetite, pharyngeal pain, stomach pain, and muscle spasms were the most common among patients treated with short-acting beta-2 analogues, with rates of 82.6%, 75%, 66.6%, 82.6%, and 80%, respectively, while hand tremors, allergic reactions, vomiting, runny nose, agitation, and diarrhea occurred. It was common in patients treated with short-acting antimuscarinics by 100%, 66.7%, 100%, 100%, 100%, and 100%, respectively. There was no significant association between the occurrence of headache and tremor in the hands, palpitations, nervous tension, chest pain, Allergic reaction, cough, lack of appetite, vomiting, nasal discharge, pharyngeal pain, agitation, contraction disturbances, stomach pain, muscle spasms, hypokalemia in patients who used short-acting bronchodilators and gender where P. value > 0.05, and in a study The average number of infusions of bronchodilators used per week in patients who have headache, tremors in the hands, palpitations, nervous tension, chest pain, allergic reaction, cough, lack of appetite, flatulence, vomiting, nasal discharge, pharyngeal pain, agitation, extrasystoles, stomach pain, Muscle spasms, hypokalemia and using short-acting bronchodilators. We found that there are no statistically significant differences in the average number of inhalations per week depending on the two types of bronchodilators used, where P value > 0.05. Discussion In this retrospective study of 100 patients with asthma and chronic obstructive pulmonary disease, approximately 80% of the patients were using short-acting beta-2 agonists, while 20% were using short-acting antimuscarinics, while 4% of the patients were using the two drugs together, perhaps the reason. It is the worsening of symptoms and the inability to control the disease. Usually, a patient with asthma or obstructive pulmonary disease needs more than one medication to control them well. (4.5). The average number of puffs for patients using bronchodilators on a weekly basis was 5.22 puffs per week, with a standard deviation of 1.8 puffs. The average number of years of using bronchodilators was 7.08 years, with a standard deviation of 1.78 years. The normal way to use an adult inhaler is: 1 or 2 puffs of a bronchodilator. Short-acting when needed a maximum of 4 times in 24 hours (regardless of whether there are 1 or 2 puffs at a time). Short-acting bronchodilators are sometimes used to prevent symptoms of shortness of breath when exercising or interacting with pets, in these cases. In this case, the normal dose is still 1 or 2 sprays at a time. If the patient needs to use his nebulizer more than 4 times in 24 hours: This means that the patient's condition is getting worse and that he needs a different treatment, and he will be more susceptible to infection. With side effects such as increased heart rate, nervousness, and headache. ( 6 ) The dose of bronchodilators cannot be increased if asthma and obstructive pulmonary disease are not well controlled because their overuse has been more closely associated with increased mortality in patients than when they are used appropriately. ( 7 ) The most common side effects suffered by patients using short-acting beta-agonists and short-acting muscarinics were headache and pharyngeal pain, at a rate of 82.6% and 17.4%, respectively. Stomach pain, muscle spasms, nervous tension, and lack of appetite were the most common in patients using short-acting beta-agonists, while Allergic reactions, hand tremors, vomiting, nasal rhinorrhea, agitation, and constriction, are common among patients using short-acting antimuscarinics. Allergic reactions are a rare and very important side effect, as they may manifest as paradoxical bronchoconstriction, urticaria, angioedema, in addition to hypotension and circulatory collapse. High doses and use may cause Long-term low blood potassium, which is a worrying complication, especially for people with kidney failure who are on diuretics and ranthine derivatives. ( 8 ) The use of the type of bronchodilator in our study was associated with the type of disease present in the patients, as it was found that the use of short-acting beta-2 agonists was more common among patients with obstructive pulmonary disease (statistical significance = 0.025), and short-acting antimuscarinics were also more common among patients with obstructive pulmonary disease, and the use of short-acting antimuscarinics was also more common among patients with obstructive pulmonary disease. Both drugs were more common in obstructive pulmonary disease (statistical significance = 0.045). The occurrence of complications was associated with the average number of years of use of each type of bronchodilator used by patients, as the average number of years of use of short-acting antimuscarinics was higher in patients who had symptoms, meaning that short-acting antimuscarinics have fewer side effects compared to short-acting beta-agonists. (statistical significance less than 0.05), although the average dose of short-acting antimuscarinics was higher in symptomatic patients (statistical significance less than 0.05). Other studies have reported an association between use of short-acting beta-agonists in excessive doses and an increased risk of side effects and death, and our study is consistent with these previous studies. (64,65,66) Although most studies on the overuse of short-acting beta-agonists were conducted in the 1990s, our findings from contemporary data underscore the fact that overuse of short-acting bronchodilators, especially beta-agonists, 2 It remains a risk factor for side effects and mortality and there is a largely dose-dependent trend at three or more packages, collected annually. ( 6 ) Our data showed 7 patients using antidepressants, hypnotics, and sedatives, suggesting a weaker patient group, regardless of whether there is a causal effect of the use of short-acting bronchodilators and these adverse effects, or whether they are primarily a sign of severe asthma and/or a reflection of patients' frailty; The increased use of short-acting bronchodilators should alert clinicians to monitor these patients more closely. ( 9 , 10 , 11 ) Conclusions This study is one of the rare studies regarding the side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease. The use of short-acting inhaled bronchodilators was accompanied by a group of side effects, but the prevalence of symptoms was distributed according to the type of bronchodilator used, as both headache and pharyngeal pain were common. In both types, while stomach pain, muscle spasms, nervous tension, and lack of appetite were common among those who used short-acting beta agonists, allergic reactions, hand tremors, vomiting, nasal congestion, agitation, and systole were common among patients using short-acting antimuscarinics, and the occurrence of symptoms was linked to an increase in the dose and duration of use. Recommendations 1. More studies are needed to understand the factors associated with the occurrence of symptoms when using inhalers and how to use them. 2. Conducting future studies aimed at studying the effect of short-acting bronchodilators on the death rate in patients with asthma and obstructive pulmonary disease who use one or more types of them. 3. Conducting scientific seminars for students and doctors and awareness campaigns for patients and explaining to them in detail the different types of short-acting bronchodilators and their indications and side effects that are known worldwide. 4. If the patient does not benefit from the prescribed dose of bronchodilators, the dose should not be increased, but rather more effective therapeutic methods should be used to control the disease, especially acute attacks. 5. Emphasize good use according to the doctor’s instructions and not excessive use. Declarations Ethics approval and consent to participate: The Research Ethics Committee at the Syrian Private University and the ethical committees at the relevant Damascus Hospital approved the study protocol. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent for publication: Not applicable. Availability of data and materials: All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request. Conflict of interest: The authors declare that they have no conflict of interest Funding: This research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors. Authors’ contributions: M.N. conceptualized the study, wrote the study protocol, performed the statistical analysis, collected data, literature searched, and interpreted the results, and wrote the main manuscript H.B. Review the draft. All authors read and approved the final draft. Acknowledgments: We are thankful to the management of the Syrian Private University and for their support in the field of medical training and research. And the medical staff at Al-Mujtahid Hospital We would also like to thank Dr. Housam AlBardan for his help and supervision in the paper. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4305151","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":294017493,"identity":"9d6a1844-4475-4446-b60a-8386c51e4e5a","order_by":0,"name":"Muhammad Najeeb","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACgwM8QJLHRo4fxEsoIEKLJURLmrFkA0iLARFa7MFaGA4nbjgAtpQILWY3co89+CFz2Nj4/OrEDw8MGOT5xQ4Q0pKXbtjDky5nduPtZgmgwwxnzk4gpCXHTIKHx9rY7MbZDSAtCQa3CWgxAGqR/MPDnLh5xtnNP4jWIs3D45y4gb93G5G2nHljJi0DDGSJG7zbLBIMJAj7xeA40GFve4BR2X92880fFTby/NIEtIABYw+QkACrlCBCORj8AGL+A8SqHgWjYBSMgpEGAJHxRgNV3ib9AAAAAElFTkSuQmCC","orcid":"","institution":"Faculty of medicine, Syrian Private University, Damascus, Syria.","correspondingAuthor":true,"prefix":"","firstName":"Muhammad","middleName":"","lastName":"Najeeb","suffix":""},{"id":294017494,"identity":"277d1648-04e4-4e35-8b16-4ad5e7ffd5a2","order_by":1,"name":"Housam AlBardan","email":"","orcid":"","institution":"Department of Internal Medicine at the Syrian Private University, Department of Internal Medicine, Damascus University, Damascus, Syria.","correspondingAuthor":false,"prefix":"","firstName":"Housam","middleName":"","lastName":"AlBardan","suffix":""}],"badges":[],"createdAt":"2024-04-22 10:37:39","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-4305151/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4305151/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55137614,"identity":"6ce1114d-9a68-4d07-8aa0-a9e3c19fc69e","added_by":"auto","created_at":"2024-04-23 06:42:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":308625,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4305151/v1/10558edc-4b78-4181-a9bb-2ec0f609e0bd.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: All authors read and approved the final draft.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eComparison of side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAsthma is known as a chronic inflammatory disease in the airways in which many inflammatory cells accumulate, especially mast cells, eosinophils, lymphocytes, and others. This accumulation leads to inflammation in the walls of the bronchial tubes, which edemas and spasms them and stimulates an increase in the secretion of sticky phlegm in them, which narrows, causing shortness of breath, coughing, and wheezing. wheezing, and these symptoms recur at night and when exposed to certain allergens that trigger this inflammatory process. Drug treatment for acute and severe asthma attacks includes giving oxygen, bronchodilators, and corticosteroids (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eChronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstruction of the flow of air out of the lungs. This disease is sometimes called emphysema or chronic bronchitis. Its symptoms include difficulty breathing, coughing, phlegm formation, and wheezing, and its infection usually occurs due to prolonged exposure. Irritating gases or particles, often emitted from cigarette smoke, and people with it are more susceptible to heart disease, lung cancer, depression, and high blood pressure in the lung arteries. Bronchodilator inhalers are the most important medications for treating chronic obstructive pulmonary disease and helping the airways relax. To keep it open, oxygen, steroids, and antibiotics may also be used to treat sudden attacks (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eBronchodilators are widely used to treat acute asthma and chronic obstructive pulmonary disease, which include β2 agonists, muscarinic receptor antagonists, and xanthin compounds. It is preferable to use the inhaled route rather than the systemic route to reduce harmful side effects. It is also preferable to use rapid and short-acting agents to treat the acute attack and the symptoms accompanying asthma. and COPD (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eImportance of studying:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOveruse of short-acting bronchodilators indicates poor asthma control and adverse health outcomes. Contemporary population data on use, risk factors and the impact of short-acting bronchodilator use on asthma exacerbations and deaths are rare, prompting the initiation of the global SABINA (Use of Short-Acting Bronchodilators in... Asthma and obstructive pulmonary disease).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives of the study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain objective:\u0026nbsp;\u003c/strong\u003eStudy of the side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary Objective:\u0026nbsp;\u003c/strong\u003eDeveloping an educational and treatment plan for doctors dealing with patients with asthma and obstructive pulmonary disease, and their families, which improves the management of these diseases, prevents their occurrence, and also reduces the occurrence of side effects of short-acting inhalation bronchodilators resulting from excessive use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient sample and study methods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design:\u0026nbsp;\u003c/strong\u003eA retrospective, cross-sectional observational study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePlace of study:\u0026nbsp;\u003c/strong\u003ePatients admitted to the Internal Thoracic Division, Damascus Hospital (Al-Mujtahid Hospital), in Damascus, Syria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDuration of study:\u0026nbsp;\u003c/strong\u003e4 years between 2020 and 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria in the study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients with asthma and obstructive pulmonary disease admitted to the Internal Thoracic Department, Damascus Hospital (Al-Mujtahid Hospital), aged (18 to 80 years).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria for the study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Patients who have other chronic lung diseases (cancers, tuberculosis).\u003c/p\u003e\n\u003cp\u003e2. Patients taking long-acting bronchodilators.\u003c/p\u003e\n\u003cp\u003e3. Patients taking systemic bronchodilators.\u003c/p\u003e\n\u003cp\u003e4. Convulsive patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected from patient files, and patients with asthma and obstructive pulmonary disease were taken within the target age group admitted to the Internal Chest Division, Damascus Hospital (Al-Mujtahid Hospital), after obtaining informed approval from the Scientific Research Ethics Committee at the Syrian Private University, and from the Director of Damascus Hospital for admission to the hospital. Archive patients to collect samples.\u003c/p\u003e\n\u003cp\u003eA detailed clinical history was taken from the patients\u0026apos; files, and the results of the clinical examination and results of monitoring vital signs were taken.\u003c/p\u003e\n\u003cp\u003eInformation was also taken about the laboratory tests performed by the patients, and the necessary radiological investigations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis methods used:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics: frequencies and percentages for qualitative variables, measures of central tendency, and measures of dispersion such as standard deviation for quantitative variables, bar and pie charts to express frequencies and percentages.\u003c/p\u003e\n\u003cp\u003eInferential statistics: Chi square test to compare nominal variables, Kolmogrov-Smirnov test to determine the normal distribution of the data, Independent Sample T test to compare continuous variables, we used Kaplan-Meier analysis to compare differences in survival between the studied groups, while using the Log Ran test to determine the statistical value. For these differences, a multivariate analysis was performed according to the Cox regression method to identify variables with future predictive value. The IBM SPSS version 28 statistical package program was used to analyze the data, and the results were considered statistically significant with a P-value \u0026lt; 0.05\u0026gt;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board (IRB) Faculty of Medicine, Syrian Private University and director of Damascus Hospital.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe ages of patients in our study ranged from 18 to 80 years, and the most common age group was 60 to 80 years, at 53%, followed by the age group from 40 to 59 years, at 28%. As for the age group, 18 to 39 years, the lowest percentage was 19%, the male/female ratio. : 61%/39%, most of the patients were retirees and employees (35%, 32%, respectively), while the percentage of workers and students was 20%, 13%, respectively. The percentage of smokers in our study was 51%, the percentage of smokers was more than one packet per day. It is the most common at 63.7%, and the rate of smoking for more than 10 years is the most common at 49.1%. In our study, we found that the rate of presence of chronic obstructive pulmonary disease is 61%, while the rate of presence of asthma is 39%. The most common medical history among the research patients was high arterial pressure at a rate of 22%. It was followed by type 2 diabetes at a rate of 18%, followed by cardiovascular diseases at a rate of 17%, the percentage of asthma was 10%, and COPD was 9%. The most common heart disease among the research patients was myocardial infarction at a rate of 10%, followed by heart failure at 4%, and the percentages of each of them were Stable and unstable angina and atrial fibrillation were 1% for each. The rate of familial asthma was 24%, the rate of use of short-acting beta-2 agonists was 80%, the rate of use of short-acting antimuscarinics was 20%, and the rate of use of both was 4%. The average The number of sprays used per week was 5.22 sprays, with a standard deviation of 1.8 sprays, and the average years of using bronchodilators was 7.08 years, with a standard deviation of 1.78 years. The average dose prescribed to the patient was 2.26 mg, with a standard deviation of 0.97 mg. Speaking of the side effects resulting from the use of short-acting bronchodilators, we found that headaches and nervous tension Decreased appetite, pharyngeal pain, stomach pain, and muscle spasms were the most common among patients treated with short-acting beta-2 analogues, with rates of 82.6%, 75%, 66.6%, 82.6%, and 80%, respectively, while hand tremors, allergic reactions, vomiting, runny nose, agitation, and diarrhea occurred. It was common in patients treated with short-acting antimuscarinics by 100%, 66.7%, 100%, 100%, 100%, and 100%, respectively. There was no significant association between the occurrence of headache and tremor in the hands, palpitations, nervous tension, chest pain, Allergic reaction, cough, lack of appetite, vomiting, nasal discharge, pharyngeal pain, agitation, contraction disturbances, stomach pain, muscle spasms, hypokalemia in patients who used short-acting bronchodilators and gender where P. value\u0026thinsp;\u0026gt;\u0026thinsp;0.05, and in a study The average number of infusions of bronchodilators used per week in patients who have headache, tremors in the hands, palpitations, nervous tension, chest pain, allergic reaction, cough, lack of appetite, flatulence, vomiting, nasal discharge, pharyngeal pain, agitation, extrasystoles, stomach pain, Muscle spasms, hypokalemia and using short-acting bronchodilators. We found that there are no statistically significant differences in the average number of inhalations per week depending on the two types of bronchodilators used, where P value\u0026thinsp;\u0026gt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective study of 100 patients with asthma and chronic obstructive pulmonary disease, approximately 80% of the patients were using short-acting beta-2 agonists, while 20% were using short-acting antimuscarinics, while 4% of the patients were using the two drugs together, perhaps the reason. It is the worsening of symptoms and the inability to control the disease. Usually, a patient with asthma or obstructive pulmonary disease needs more than one medication to control them well. (4.5).\u003c/p\u003e \u003cp\u003eThe average number of puffs for patients using bronchodilators on a weekly basis was 5.22 puffs per week, with a standard deviation of 1.8 puffs. The average number of years of using bronchodilators was 7.08 years, with a standard deviation of 1.78 years. The normal way to use an adult inhaler is: 1 or 2 puffs of a bronchodilator. Short-acting when needed a maximum of 4 times in 24 hours (regardless of whether there are 1 or 2 puffs at a time). Short-acting bronchodilators are sometimes used to prevent symptoms of shortness of breath when exercising or interacting with pets, in these cases. In this case, the normal dose is still 1 or 2 sprays at a time. If the patient needs to use his nebulizer more than 4 times in 24 hours: This means that the patient's condition is getting worse and that he needs a different treatment, and he will be more susceptible to infection. With side effects such as increased heart rate, nervousness, and headache. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe dose of bronchodilators cannot be increased if asthma and obstructive pulmonary disease are not well controlled because their overuse has been more closely associated with increased mortality in patients than when they are used appropriately. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe most common side effects suffered by patients using short-acting beta-agonists and short-acting muscarinics were headache and pharyngeal pain, at a rate of 82.6% and 17.4%, respectively. Stomach pain, muscle spasms, nervous tension, and lack of appetite were the most common in patients using short-acting beta-agonists, while Allergic reactions, hand tremors, vomiting, nasal rhinorrhea, agitation, and constriction, are common among patients using short-acting antimuscarinics. Allergic reactions are a rare and very important side effect, as they may manifest as paradoxical bronchoconstriction, urticaria, angioedema, in addition to hypotension and circulatory collapse. High doses and use may cause Long-term low blood potassium, which is a worrying complication, especially for people with kidney failure who are on diuretics and ranthine derivatives. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe use of the type of bronchodilator in our study was associated with the type of disease present in the patients, as it was found that the use of short-acting beta-2 agonists was more common among patients with obstructive pulmonary disease (statistical significance\u0026thinsp;=\u0026thinsp;0.025), and short-acting antimuscarinics were also more common among patients with obstructive pulmonary disease, and the use of short-acting antimuscarinics was also more common among patients with obstructive pulmonary disease. Both drugs were more common in obstructive pulmonary disease (statistical significance\u0026thinsp;=\u0026thinsp;0.045).\u003c/p\u003e \u003cp\u003eThe occurrence of complications was associated with the average number of years of use of each type of bronchodilator used by patients, as the average number of years of use of short-acting antimuscarinics was higher in patients who had symptoms, meaning that short-acting antimuscarinics have fewer side effects compared to short-acting beta-agonists. (statistical significance less than 0.05), although the average dose of short-acting antimuscarinics was higher in symptomatic patients (statistical significance less than 0.05).\u003c/p\u003e \u003cp\u003eOther studies have reported an association between use of short-acting beta-agonists in excessive doses and an increased risk of side effects and death, and our study is consistent with these previous studies. (64,65,66) Although most studies on the overuse of short-acting beta-agonists were conducted in the 1990s, our findings from contemporary data underscore the fact that overuse of short-acting bronchodilators, especially beta-agonists, 2 It remains a risk factor for side effects and mortality and there is a largely dose-dependent trend at three or more packages, collected annually. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOur data showed 7 patients using antidepressants, hypnotics, and sedatives, suggesting a weaker patient group, regardless of whether there is a causal effect of the use of short-acting bronchodilators and these adverse effects, or whether they are primarily a sign of severe asthma and/or a reflection of patients' frailty; The increased use of short-acting bronchodilators should alert clinicians to monitor these patients more closely. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study is one of the rare studies regarding the side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease. The use of short-acting inhaled bronchodilators was accompanied by a group of side effects, but the prevalence of symptoms was distributed according to the type of bronchodilator used, as both headache and pharyngeal pain were common. In both types, while stomach pain, muscle spasms, nervous tension, and lack of appetite were common among those who used short-acting beta agonists, allergic reactions, hand tremors, vomiting, nasal congestion, agitation, and systole were common among patients using short-acting antimuscarinics, and the occurrence of symptoms was linked to an increase in the dose and duration of use.\u003c/p\u003e"},{"header":"Recommendations","content":"\u003cp\u003e1. More studies are needed to understand the factors associated with the occurrence of symptoms when using inhalers and how to use them.\u003c/p\u003e\n\u003cp\u003e2. Conducting future studies aimed at studying the effect of short-acting bronchodilators on the death rate in patients with asthma and obstructive pulmonary disease who use one or more types of them.\u003c/p\u003e\n\u003cp\u003e3. Conducting scientific seminars for students and doctors and awareness campaigns for patients and explaining to them in detail the different types of short-acting bronchodilators and their indications and side effects that are known worldwide.\u003c/p\u003e\n\u003cp\u003e4. If the patient does not benefit from the prescribed dose of bronchodilators, the dose should not be increased, but rather more effective therapeutic methods should be used to control the disease, especially acute attacks.\u003c/p\u003e\n\u003cp\u003e5. Emphasize good use according to the doctor\u0026rsquo;s instructions and not excessive use.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Ethics Committee at the Syrian Private University and the ethical committees at the relevant Damascus Hospital approved the study protocol. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data related to this paper\u0026rsquo;s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.N. conceptualized the study, wrote the study protocol, performed the statistical analysis, collected data, literature searched, and interpreted the results, and wrote the main manuscript H.B. Review the draft. All authors read and approved the final draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are thankful to the management of the Syrian Private University and for their support in the field of medical training and research. And the medical staff at Al-Mujtahid Hospital We would also like to thank Dr. Housam AlBardan for his help and supervision in the paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbbott-Banner KH, Page CP (2014) Dual PDE3/4 and PDE4 inhibitors: novel treatments for COPD and other inflammatory airway diseases. Basic Clin Phar- macol Toxicol 114:365\u0026ndash;376\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdachi M, Aizawa H, Ishihara K, Ohta K, Sano Y, Taniguchi H, Nakashima M (2008) Comparison of salmeterol/fluticasone propionate (FP) combination with FP1sustained release theophylline in moderate asthma patients. 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PLoS ONE 10:e0125620 [PMC free article] [PubMed] [Google Scholar]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBateman ED, Hurd SS, Barnes PJ et al (2008) Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 31:143\u0026ndash;178 [PubMed] [CrossRef] [Google Scholar]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbramson MJ, Walters J, Walters EH (2003) Adverse effects of beta-agonists: are they clinically relevant? Am J Respir Med 2:287\u0026ndash;297 [PubMed] [CrossRef] [Google Scholar]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e24, Martin MJ, Harrison TW (2019) Is it time to move away from short-acting beta-agonists in asthma management? Eur Respir J 53:1802223 [PubMed] [Google Scholar]\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"afa1db31-fa88-4789-ad7b-6121f0b05080","identifier":"10.13039/100016418","name":"B.K. Kee Foundation","awardNumber":"0996066591","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Syrian Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"side effects, short-acting bronchodilators, asthma, obstructive pulmonary disease","lastPublishedDoi":"10.21203/rs.3.rs-4305151/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4305151/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Excessive use of short-acting inhaled bronchodilators indicates poor asthma control and adverse health outcomes. The research aims to study the side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design:\u003c/strong\u003eRetrospective, cross-sectional observational study, location. Study: Patients admitted to the Internal Thoracic Division, Damascus Hospital (Al-Mujtahid Hospital), in Damascus, Syria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDuration of the study:\u003c/strong\u003e 4 years between 2020 and 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria:\u003c/strong\u003e All patients with asthma and obstructive pulmonary disease admitted to the Internal Thoracic Division, Damascus Hospital (Al-Mujtahid Hospital) whose ages range from 18 to 80 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e Patients with other chronic lung diseases (cancers, tuberculosis), patients taking long-acting bronchodilators, patients taking systemic bronchodilators, patients with cachexia.\u003c/p\u003e\n\u003cp\u003eData analysis was performed using SPSS-28 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Patients’ ages ranged from 18 to 18 years. -80 years, and the most common age group is 60-80 years, and 61% of patients are male. Headaches, nervous tension, lack of appetite, pharyngeal pain, stomach pain, and muscle spasms were most common among patients treated with short-acting beta-2 analogues, with rates of 82.6% and 75%. 66.6%, 82.6%, and 80%, respectively, while hand tremors, allergic reaction, vomiting, runny nose, agitation, and contractile convulsions were more common in patients treated with short-acting antimuscarinics, with rates of 100%, 66.7%, 100%, 100%, 100%, 100%, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The use of short-acting bronchodilators was accompanied by a group of side effects, as headache and pharyngeal pain were common in all types, while stomach pain, muscle spasms, nervous tension, and lack of appetite were common in those who used to short-act beta agonists, and allergic reaction, hand tremors, and vomiting. Rhinorrhea, irritability, and constriction were more common among patients using short-acting antimuscarinics, and the occurrence of symptoms was associated with increasing dose and duration of use.\u003c/p\u003e","manuscriptTitle":"Comparison of side effects of short-acting inhaled bronchodilators in patients with asthma and chronic obstructive pulmonary disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-23 06:34:01","doi":"10.21203/rs.3.rs-4305151/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fd298f6c-f69b-4c59-b135-45d6e5208bb9","owner":[],"postedDate":"April 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30988080,"name":"Pulmonology"}],"tags":[],"updatedAt":"2024-04-23T06:34:01+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-23 06:34:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4305151","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4305151","identity":"rs-4305151","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}