Association between exposure to beta 2 agonists and corticosteroids and acquiring benign joint hypermobility syndrome among asthmatic patients: a case-control study

Abstract

Background: Beta2 (?2) agonists as relievers and corticosteroids as controllers are the mainstay drugs for asthma treatment. Benign Joint Hypermobility Syndrome (BJHS) is a connective tissue disorder with musculoskeletal symptoms. We had examined the possible association between the use of ?2 agonists and corticosteroids and acquiring BJHS in asthmatic patients.

Methods: This was a case-control, hospitalbased study including a group of asthmatics who had BJHS (cases), compared with a matched group of asthmatics without BJHS (controls) for the ?2 agonists and corticosteroids past and current pattern of use. Information was collected by faceto-face interview and clinical examination and from subjects’ medical records using pre-structured questionnaire. BJHS diagnosis was based on the revised Brighton criteria. Asthma severity was reflected by a score, which was calculated from the asthma questionnaire. Comparison of exposure was done by Calculation of Odds Ratio.

Results: Development of BJHS was found to be significantly associated with chronicity of asthma of average duration of 13.2 years, and hence to prolonged use of ?2 agonists and/or corticosteroids (OR 1.019; 95% CI 0.999 - 1.039, P=0.006). Exposure to ?2 agonist and corticosteroid (87 and 79 cases and controls respectively P=0.05) high asthma score (42.9 ± 9.8 and 40.4 ± 8.3 among cases and controls respectively, P=0.011) were significantly associated with the development of BJHS.

Conclusion: Frequent and prolonged use of ?2 agonists and corticosteroids is significantly associated with acquiring BJHS. Implying a possibility of changing approach and handling in asthmatics follow up. Prospective and experimental studies are needed to support the evidence of association.

Keywords: Bronchial Asthma, Benign Joint Hypermobility Syndrome, Beta 2 agonists, Corticosteroids, Brighton criteria, Beighton score