From the Guidelines
Adenosine is contraindicated in asthma patients due to its potential to cause severe bronchospasm. Adenosine, typically used for treating supraventricular tachycardia, can trigger acute bronchoconstriction in asthmatics, as reported by CUSHLEY et al. 1 and PHILLIPS et al. 1. This effect is particularly dangerous because it can lead to sudden and severe airway narrowing, potentially causing a life-threatening asthma attack. The mechanism behind this contraindication involves adenosine's action on A2B receptors in the lungs, which can lead to mast cell degranulation and the release of inflammatory mediators, resulting in airway constriction 1.
Key Considerations
- Healthcare providers should be aware of a patient's asthma history before administering adenosine, as stated in the American Heart Association committee on diagnostic and interventional cardiac catheterization, council on clinical cardiology 2.
- Alternative treatments for supraventricular tachycardia, such as verapamil or diltiazem, may be considered for asthmatic patients.
- In emergency situations where adenosine must be used in an asthmatic patient, close monitoring and immediate access to bronchodilators and other emergency asthma medications are crucial to manage potential respiratory complications.
Clinical Implications
- Asthma is a contraindication for intravenous adenosine administration, as it can cause bronchospasm, especially in patients with severe obstructive pulmonary disease 2.
- The choice of alternative medication should be made on a case-by-case basis, considering the patient's overall health status and other potential contraindications.
From the FDA Drug Label
Adenosine injection is contraindicated in patients with: • Known or suspected bronchoconstrictive or bronchospastic lung disease (e.g., asthma) Adenosine injection administration can cause dyspnea, bronchoconstriction, and respiratory compromise. Do not use in patients with bronchoconstriction or bronchospasm (e.g., asthma).
Adenosine is contraindicated in asthma because it can cause bronchoconstriction and respiratory compromise. The drug label explicitly states that adenosine should not be used in patients with bronchoconstriction or bronchospasm, including those with asthma 3, 4.
From the Research
Adenosine Contraindication in Asthma
- Adenosine is contraindicated in asthma due to its potential to cause bronchoconstriction in asthmatic patients 5, 6, 7, 8, 9.
- The mechanism of adenosine-induced bronchoconstriction is thought to involve the release of inflammatory mediators from mast cells via activation of the A(2B) receptor 7.
- Adenosine can also act on A(1), A(2A), and A(3) receptors, which may contribute to its bronchoconstrictor effects 7.
- Theophylline, a medication commonly used to treat asthma, has been shown to antagonize adenosine-induced bronchoconstriction 6, 8.
- Studies have demonstrated that inhaled adenosine causes bronchoconstriction in asthmatic patients, but not in normal subjects 5, 6, 9.
Key Findings
- A study published in 2007 found that adenosine stress testing was safe and well-tolerated in patients with mild asthma or COPD who were pretreated with an inhaled beta(2)-adrenergic agonist 5.
- Another study published in 1984 found that inhaled theophylline significantly inhibited adenosine-induced bronchoconstriction in asthmatic patients 6.
- A review article published in 2007 discussed the role of adenosine receptors in the treatment of asthma and COPD, highlighting the potential for adenosine receptor modulation as a therapeutic strategy 7.
- A study published in 1989 found that adenosine contracted human bronchial smooth muscle in vitro and induced bronchoconstriction in asthmatic patients when administered by inhalation 8.
- A study published in 1985 investigated the roles of cholinergic reflex stimulation and decreased beta 2-adrenoceptor responsiveness in adenosine-induced bronchoconstriction in asthma 9.