Asthma Management Handbook
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Table. Treatment-related adverse effects reported in older people with asthma

Class of medicine

Potential adverse effects

Clinical action

Beta2 agonists

Inotropic and chronotropic effects may worsen heart disease (e.g. arrhythmias, cardiomyopathy, myocardial ischaemia) or cause electrolyte disturbances.

Minimise need for short-acting beta2 agonists by maintaining good asthma control with preventer treatment as indicated.

Inhaled corticosteroids

Long-term high doses may slightly increase risk of bone fractures.

Overall, treatment does not appear to increase bone fracture risk in patients with COPD or asthma aged 40 years or over (meta-analysis of randomised controlled clinical trials).

Prescribe minimal dose needed to maintain good asthma control.

Back-titrate dose in patients who have maintained good control for several months.

Combination inhaled corticosteroid/long-acting beta2 agonist

Overall, treatment does not appear to increase risk (composite measure including asthma-related hospitalisations, deaths, and intubations) among patients aged ≥ 65 years (meta-analysis of controlled clinical trials comparing long-acting beta2 agonists with no long-acting beta2 agonist treatment).

Prescribe if indicated, as for younger adults.


Metabolised mainly by the liver.

May interact with other medicines.

Monitor plasma concentration if theophylline needed to manage acute asthma.

Avoid regular theophylline treatment.


Gupta P, O'Mahony MS. Potential adverse effects of bronchodilators in the treatment of airways obstruction in older people: recommendations for prescribing. Drugs Aging 2008; 25: 415-43. Available from:

Etminan M, Sadatsafavi M, Ganjizadeh Zavareh S et al. Inhaled corticosteroids and the risk of fractures in older adults: a systematic review and meta-analysis. Drug Saf 2008; 31: 409-14. Available from:

McMahon AW, Levenson MS, McEvoy BW et al. Age and risks of FDA-approved long-acting β2-adrenergic receptor agonists. Pediatrics 2011; 128: e1147-54. Available from:

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