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Best evidence topic report
Using intravenous adenosine in asthmatics
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  1. Polly Terry,
  2. Gail Lumsden
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK

    http://dx.doi.org/10.1136/emj.18.1.61

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      Report by Polly Terry, Specialist Registrar Search checked by Gail Lumsden, Specialist Registrar

      Clinical scenario

      A 32 year old woman with asthma presents to the emergency department with a 20 minute history of palpitations. On examination she is cardiovascularly stable, there is no bronchospasm and the ECG shows a supraventricular tachycardia (SVT) that fails to respond to vagal manoeuvres. You would like to use intravenous adenosine but you are aware that asthma is a contraindication treatment. You wonder what evidence there is that intravenous adenosine will cause bronchospasm.

      Three part question

      [In an asthmatic patient with a SVT] is [treatment with adenosine] associated with [an increased risk of bronchospasm]?

      Search strategy

      Medline 1966–09/00 using the OVID interface. ([exp tachycardia OR exp tachycardia, supraventricular OR narrow complex tachycardia.mp OR exp arrythmia OR exp tachycardia OR dysrhythmia.mp] AND [exp asthma OR asthma.mp OR exp respiratory sounds OR wheezing.mp OR exp bronchial spasm OR bronchospasm.mp] AND (exp adenosine OR adenosine.mp OR adenosine.ae.ct]) LIMIT to human AND english.

      Search outcome

      Altogether 16 papers were found of which 14 were irrelevant or of insufficient quality for inclusion. The remaining two papers are shown in table 3.

      View this table:
      Table 3

      Comments

      There is very little evidence recording the effect of intravenous adenosine on asthmatic airways. Many studies have documented that inhaled adenosine is a potent bronchoconstrictor in the asthmatic but not normal patients. In the literature there are four case reports of patients with asthma or COAD developing bronchospasm following treatment with intravenous adenosine. This level of evidence has many limitations. Similarly there are many studies looking at the efficacy of adenosine that report no “significant side effects” some specifically mention no patients reported bronchospasm.

      Clinical bottom line

      At worst adenosine is only relatively contraindicated in the treatment asthmatic patients with supraventricular tachycardia.

      Report by Polly Terry, Specialist Registrar Search checked by Gail Lumsden, Specialist Registrar

      References

      1. Larsson K, Sollevi A. Influence of infused adenosine on bronchial tone and bronchial reactivity in asthma. Chest1988;93:280–4.
        OpenUrlCrossRefPubMedWeb of Science
      2. Losek JD, Endrom E, Dietrich A, et al. Adenosine and pediatric supraventricular tachycardia in the emergency department: multicenter study and review. Ann Emerg Med1999;33:185–91.
        OpenUrlCrossRefPubMedWeb of Science