Breath of Fresh Air: Feature Articles

The recent sudden death of a teenage model, Krissy Taylor, filled popular newspapers and magazines with concern over the safety of an over-the-counter asthma medication, Primatene Mist®. She had been thought to have no serious medical problems and had been using Primatene Mist® prior to her death. Could the Primatene Mist® have caused her death? More broadly, do the inhaled bronchodilating medications used at some time by virtually all persons with asthma put one in some kind of medical danger?

According to articles in the lay press, Krissy Taylor was an occasional cigarette smoker who with colds would develop a wheezy cough and chest congestion. Prior to her death her doctor reportedly prescribed an antibiotic, steroids, and a prescription bronchodilator inhaler for a respiratory infection, but she relied on the Primatene Mist®. Because of the sudden death of a seemingly healthy young girl, the question was raised as to whether her death might have been caused by one of her medications.

Was the death of this young model caused by her use of a bronchodilator inhaler, Primatene Mist®?

Primatene Mist® contains epinephrine (also called adrenaline). Because epinephrine can stimulate the heart to beat more rapidly and forcefully than normal, concern focused on the possible dangers of this medication. Epinephrine is a natural hormone of the human body. It is released into the blood from nerve endings and from the adrenal gland, especially at times of stress or fear. If you have ever had someone sneak up behind you and frighten you, you have felt the effects of "adrenaline" released into your blood: your heart pounds, you feel a "fluttering" in your stomach, your hands tremble, etc. Adrenaline also has the effect of opening the bronchial tubes wider than usual—bronchodilation.

Concern about the possibility of irregular heart rhythms, heart attacks, and death from inhaled asthma medications that also stimulate the heart is not new. In the 1960's concern in England about causes of death among persons with asthma focused on a derivative of adrenaline called isoproterenol. Again in the 1980's an "epidemic" of asthma deaths in New Zealand was blamed in part on a new inhaled bronchodilator used there, called fenoterol. However, even in these examples, many scientists have doubted that the medications caused the deaths. Most persons who die of asthma—and these deaths are fortunately still very rare—die of an inability to breathe from severe blockage of the bronchial tubes, not from irregularities of the heart rhythm.

Deaths from asthma are caused by the inability to breathe, rarely by irregular heart rhythms.

The sad case of Krissy Taylor illustrates the difficulty one has in assigning the correct cause of death. When an autopsy was performed, the coroner discovered severe inflammation of the bronchial tubes and attributed her death to asthma (as reported in The Wall Street Journal). It appears that this young woman suffered from unrecognized and undertreated asthma. Perhaps the medications prescribed by her physician, including the steroid medication used to treat asthmatic inflammation of the bronchial tubes, might have saved her life. Overuse of Primatene Mist® may have contributed to her death — not because of any toxic effect of the medication, but because this medication failed to treat the swelling of the bronchial tubes and excess mucus clogging those tubes, aspects of asthma that ultimately made it impossible for her to breathe.

As you consider this unfortunate death, keep in mind the following facts:

1. Prescription bronchodilator inhalers have less stimulatory effects on heart than the over-the-counter Primatene Mist®;
2. In persons without serious underlying heart disease, the risk of serious heart rhythm irregularities is extremely low when prescription bronchodilator inhalers are used in the way prescribed by your doctor;
3. The risk of death from asthma is much greater from undertreatment of severe narrowing of the bronchial tubes than it is from complications due to overuse of asthma medications;
   
4. The importance of treating the underlying inflammation of the airways in asthma is highlighted by this sad death.
   

Overreliance on Primatene Mist® may have contributed to undertreatment of of swollen, mucus-filled bronchial tubes.