Is it safe to use long-acting beta-agonists in asthma and chronic obstructive pulmonary disease? Implications of recent trials and meta-analyses.
The safety of long-acting beta-agonists (LABAs) has been hotly debated for several years, with surveillance studies suggesting increased risk of mortality, especially with use of LABA without inhaled corticosteroid (ICS). Meta-analyses of selected trials, especially those dominated by one large study, report significantly increased risks for mortality and Serious Adverse Events (SAEs). Review of all of the available evidence from clinical trials, and meta-analyses using different selection criteria, suggests that LABA with ICS in fact significantly reduces SAEs. The risk of mortality is more difficult to assess, but post-hoc analyses suggest the risk is increased with LABA monotherapy and not with concomitant use of ICS. In both asthma and chronic obstructive pulmonary disease, concomitant use of ICS should be considered best practice whenever LABAs are used.
Sears
Malcolm R
MR
Firestone Institute for Respiratory Health, St. Joseph's Healthcar, McMaster University, Hamilton, ON, Canada. searsm@mcmaster.ca
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D006801:Humans; D015201:Meta-Analysis as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents