Asthma And Heart Disease - Managing Your Asthma: Asthma

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Asthma and heart disease

Many older people with asthma are also taking medications for high blood pressure, heart disease, or both. If you are one of these people, you may be concerned about the effect these medications have on your asthma — and the effect your asthma medications have on your heart disease.

Most people with asthma and heart disease can take their high blood pressure and cholesterol-lowering medications without worry about worsening their asthma. There is one exception to this general rule: People with asthma are uniquely sensitive to beta blockers, used to treat high blood pressure and heart disease, among other conditions. Some beta blockers such as propranolol (Inderal) have particularly strong effects on the bronchial tubes, causing constriction and thereby triggering an asthma attack (see "Medication triggers"). More selective beta blockers such as atenolol (Tenormin) and metoprolol (Lopressor) are available; these act mainly on the heart and blood vessels and have less of an effect on the lungs. People with mild to moderate asthma may be able to safely take a low dose of selective beta blocker without triggering an asthma attack. However, it's best to check with your physician about this issue. One option is to receive a test dose of the beta blocker in your doctor's office, where your breathing can be closely monitored and any flare-up of your asthma promptly treated.

Asthma flare-ups can also be triggered by intravenous agents used to stimulate the heart in some cardiac stress tests. Examples include adenosine (Adenoscan) and dipyridamole (Persantine), which can trigger bronchial tube constriction. If you require a cardiac evaluation, alternative methods are available. You need only remember to tell your primary care doctor or cardiologist that you have asthma.

If you have heart disease, you may also be more sensitive to the action of certain bronchodilators used to treat asthma. The quick-acting bronchodilators, for instance, tend to have stimulatory side effects similar to those of adrenaline. Generally these effects are slight and of no significance, but occasionally people with certain heart diseases are sensitive to even these minor effects.

If you have high blood pressure, you may be worried about using a beta-2 agonist bronchodilator because of a common misconception — that this medicine raises blood pressure. In fact, beta-2 agonist bronchodilators do not elevate blood pressure, so they are safe to use, in spite of what you may have heard.

If you have very active angina (chest pain from inadequate blood supply to the heart) or serious cardiac arrhythmias with rapid heartbeat, then even the minor cardiac stimulation from inhaled bronchodilators might aggravate your heart condition. No perfect alternative is available. Your doctor might recommend you try one puff of your quick-acting bronchodilator rather than two, or you might try another type of bronchodilator, such as ipratropium (Atrovent), which is neither as strong nor as quick-acting as the beta-agonist bronchodilators, but has fewer stimulatory effects on the heart. Another option is the single-isomer form of albuterol, levalbuterol (Xopenex). A low dose of levalbuterol may make the heart race less than albuterol.

Last updated:	September 27, 2007