Safety of long-acting beta-agonists in asthma: a review.
OBJECTIVE
This review highlights a growing literature regarding the safety of long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids.


RESULTS
Two studies have demonstrated a mortality increase with use of long-acting beta-2 agonists in asthmatic patients. They were not well controlled and thus raise the question of whether this mortality increase was the result of using long-acting beta-2 agonists as monotherapy or whether there is some rare susceptibility to an untoward effect of this class of medicine.


CONCLUSIONS
When inhaled corticosteroids and long-acting beta-2 agonists are used in combination, prospective studies demonstrate improvement in asthma control and exacerbation rate. Two studies showed an increase in asthma mortality with long-acting beta-2 agonists, but they allowed beta-2 agonists to be used as monotherapy and did not address the safety of their appropriate use in conjunction with inhaled corticosteroids. Although the majority of asthmatic patients appear to benefit from the use of long-acting beta-2 agonists, a small subclass may be prone to deleterious effect. It is uncertained whether this is some rare susceptibility to these drugs, or, more likely, that this is the consequence of monotherapy with long-acting beta-2 agonists controlling the signs and symptoms while masking inflammation.
Oppenheimer
John
J
UMDNJ-New Jersey Medical School, Pulmonary and Allergy Association, Summit, New Jersey 07901, USA. Nallopp@pol.net
Nelson
Harold S
HS
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D001741:Black or African American / Q000235:genetics; D000420:Albuterol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D001249:Asthma / Q000139:chemically induced / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D004359:Drug Therapy, Combination; D020022:Genetic Predisposition to Disease; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D020641:Polymorphism, Single Nucleotide; D018343:Receptors, Adrenergic, beta-2 / Q000235:genetics; D020545:Respiratory Mucosa / Q000187:drug effects / Q000276:immunology; D000068299:Salmeterol Xinafoate
D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D018343:Receptors, Adrenergic, beta-2; D000068299:Salmeterol Xinafoate; D000420:Albuterol