The effects of an inhaled β2-adrenergic agonist on lower esophageal function -: A dose-response study

Study objectives: Albuterol, a beta (2)-adrenergic agonist that is commonly used to treat asthma, reduces bronchial smooth muscle tone. The pharmacodynamics of inhaled albuterol on esophageal function were studied in healthy volunteers. Design: A prospective, randomized, placebo-controlled, double-blind crossover design. Setting: An academic medical center. Patients: Nine healthy, volunteers (five men, four women; age, 22 to 30 years). Interventions: Albuterol (2.5 to 10 mg) or placebo was given via nebulizer. Volunteers were studied at two sessions, 1 week apart, using a 6-cm manometry assembly and a low-compliance pneumohydraulic pump. The percentage of lower esophageal sphincter (LES) relaxation, the frequency of transient LES relaxations (TLESRs), and the amplitude, duration, and propagation velocity of esophageal contractions were measured at 5 and 10 em above the LES. Dependent measures were evaluated using two-way, repeated-measures analysis of variance. Measurements and results: Albuterol therapy reduced LES basal tone in a dose-dependent manner (baseline, 17.0 +/- 2.6 mm Hg; at 10 mg, 8.9 +/- 2.1 mm Hg; p = 0.01). The frequency of TLESRs was not different from placebo (not significant). Albuterol reduced the amplitude of esophageal contractions at 5 cm above the LES (baseline, 72.5 +/- 18.6 mm Hg; at 10 mg, 48.8 +/- 10.0 mm Hg; p < 0.05). A significant reduction in esophageal body contractile amplitudes was noted at 10 em (F[1,6] = 7.05; p < 0.05). Conclusions: Inhaled albuterol reduced LES basal tone and contractile amplitudes in the smooth muscle esophageal body in a dose-dependent manner. Inhaled beta (2)-agonists may increase the likelihood of acid reflux in a subset of patients who receive cumulative dosing.