Side effect profile and tolerability of adenosine myocardial perfusion scintigraphy in patients with mild asthma or chronic obstructive pulmonary disease

Background: Adenosine may cause bronchoconstriction in subjects with asthma or chronic obstructive pulmonary disease (COPD). Recent evidence suggests that this effect may be dependent on the severity of disease. This study investigates the tolerability of adenosine stress in patients with mild asthma or COPD undergoing myocardial perfusion scintigraphy. Methods and Results: In this case-control study patients with known or suspected mild asthma or COPD were pretreated with an inhaled β₂-adrenergic agonist and adenosine titrated up to the maximal dose of 140 μg·kg⁻¹ ·min⁻¹ over a period of 6 minutes. The occurrence of side effects and test tolerability were compared between the airway disease group and 72 control subjects. Of 1261 patients, 124 had known or suspected airway disease; of these, 72 (58%) were suitable for adenosine stress. The proportion of tests completed as per protocol in the asthma/COPD group was similar to that of control subjects (93% vs 100%, P = .06). Dyspnea (n = 38 [53%] in asthma/COPD group vs n = 25 [35%] in control group, P = .03) and chest pain (n = 14 [19%] in asthma/COPD group vs n = 16 [22%] in control group, P = .7) were the most common side effects, and these were mostly mild and well tolerated. Bronchospasm occurred in 5 patients with asthma/COPD but reverted shortly after discontinuation of the adenosine infusion. Aminophylline was not required in any case. Conclusions: A stepwise 6-minute adenosine infusion with prophylactic β₂-adrenergic agonist is safe and well tolerated in patients with mild asthma or COPD. [Copyright &y& Elsevier]