We seem to use beta-agonists for everything that wheezes these days. While these agents are technically for asthma, we routinely use nebulized albuterol for pneumonia, chronic obstructive pulmonary disease, bronchiolitis, bronchitis, croup, and congestive heart failure (CHF). I have read about potential dangers in CHF patients. Should we be restricting our use of beta-agonists?
—Richard Allen, MD, Brookline, Mass.

Beta-agonist agents have well-recognized arrhythmogenic effects. When given to patients with CHF, especially CHF due to systolic dysfunction, this effect will be magnified. Theoretically, beta-agonists also can worsen CHF, just the opposite of the beneficial effects often seen with beta blockers. So the answer to Dr. Allen’s question is an emphatic “yes.” Even when the beneficial effects of treating pulmonary disease clearly outweigh the cardiac dangers noted, use beta-agonist agents sparingly—and only for short periods of time, if possible.
—Peter F. Cohn, MD (118-5)