Sunday, February 3, 2013

The Association Between Asthma and Atrial Fibrillation


    I cannot tell you how many inquiries I have received concerning the association between asthma and atrial fibrillation.  In medical schools and in better nursing schools, students are taught that poorly controlled asthma can move on to status asthmaticus, or to arrhythmias, atrial fibrillation being the most common of these.  However, I do want to expound a little on this.
            Yes, the medical references exist indicating that poorly controlled asthma can trip a susceptible individual into atrial fibrillation or into atrial flutter and atrial fibrillation.  Sometimes however, the treatment of asthma itself can trip the individual into an arrhythmia.
            When we treat acute asthma, one of the modalities used is an inhaler or in a nebulizer or both, which is often a potent bronchodilator named albuterol.   Albuterol, in simple terms, simulates the activation of the fight or flight response, and in addition to opening the airways as if you are running, speeds heart rate.   In susceptible individuals, the simple act of speeding the heart rate trips some into atrial fibrillation.  So, sometimes the treatment of asthma, and not simply its poor management can also trip you, or your patient into an episode of atrial fibrillation, with all of its inherent hazards.
           If you are a patient, or are treating a patient with an atrial fibrillation history, either personal or familial, then you may wish to consider treating such patients, not with albuterol sulfate, but with an analog of such, called Levalbuterol.   Levalbuterol  is sold under the brand name Xopenex, as both an inhaler, and as a liquid for inhalation via nebulizer.  It is most often ordered for those with cardiac issues.  Fairly recently, a generic has become available for Xopenex, called Levalbuterol.    Levalbuterol is an analog of the original drug.  This means that modifications to the molecules of this drug were altered during manufacture, in order to create a drug without the undesirable feature of racing the patient's heart. This can be invaluable for a great many patients.

         Unfortunately, unless you are an allergist/immunologist, you don't know about Xopenex, or that a cheaper generic version for such, (levalbuterol)  is available. A great many family physicians, pharmacists and nurses are unaware of this, as of this posting date.

           In conclusion, poorly controlled asthma can be a risk factor for heart rhythm disturbances. Treating a susceptible patient with albuterol sulfate can also trip him/her into arrhythmia.  Sometimes, this cannot be initially anticipated.  However, a patient who avoids using his asthma medications because they race his heart, should probably be switched to Levalbuterol, or at least have such a change discussed and considered.  I hope this piece of information is helpful to physicians, nurse practitioners, and to patients alike.

     I have no personal investment or any possibility of personal gain for either Xopenex, or it's original manufacturer Sepracor, or for Levalbuterol Sulfate, from any generic manufacturer.
     The above named drugs are not suitable for all patients. Asthmatic patients should discuss any changes to their regime at length with their prescribing physician.

This is the molecular structure of Levalbuterol, which is sometimes also called Levsalbutamol.


lotta joy said...

IS this weird or what? In the past, my inhaler caused my heart to fib into the 180s and I would literally VIBRATE.

I was given one for my inhaler and nebulizer that did not cause that problem and, here I am in Florida and wondering what it was.

I'm also thinking of switching from my Indian doctor who does not freely prescribe medicine, to an older gentleman who graduated from University of Indiana where I attended.

Maybe one fellow Hoosier will be more receptive to helping another Hoosier?

Now I'll at least have a name to request: Levalbuterol


JaneofVirginia said...

Glad it was a timely post Joy, This is a problem far more than people realize, and a lot of physicians simply don't know about it yet. I have brought it to the attention of all of the physicians with whom I work or have worked, at the free clinic.