title: Long-acting beta-agonists with and without inhaled corticosteroids and catastrophic asthma events.
abstract: BACKGROUND
  It is unclear whether long-acting beta-agonists with concomitant inhaled corticosteroids increase asthma-related intubations and deaths. We pooled data on long-acting beta-agonists with variable and concomitant inhaled corticosteroids to evaluate the risk for catastrophic asthma events.
  
  
  METHODS
  We conducted searches of electronic databases, the US Food and Drug Administration website, clinical-trials registries, and selected references through December 2008. We analyzed randomized controlled trials in patients with asthma, which lasted at least 3 months, evaluated long-acting beta-agonists compared with placebo or long-acting beta-agonists with inhaled corticosteroids compared with corticosteroids alone, and included at least 1 catastrophic event, defined as asthma-related intubation or death.
  
  
  RESULTS
  In pooled trial data that included 36,588 participants, long-acting beta-agonists increased catastrophic events 2-fold (Peto odds ratio [OR] 2.10; 95% confidence interval [CI], 1.37-3.22). Statistically significant increases were seen for long-acting beta-agonists with variable corticosteroids compared with placebo (OR 1.83; 95% CI, 1.14-2.95) and for concomitant treatment with corticosteroids compared with corticosteroids alone (OR 3.65; 95% CI, 1.39-9.55). Similar increases in risk were seen for variable and concomitant corticosteroid use, salmeterol and formoterol, and children and adults. When the analysis was restricted to trials with controlled corticosteroid use, given as part of the study intervention, concomitant treatment still increased catastrophic events compared with corticosteroids alone (OR 8.19; 95% CI, 1.10-61.18).
  
  
  CONCLUSIONS
  Long-acting beta-agonists increase the risk for asthma-related intubations and deaths, even when used in a controlled fashion with concomitant inhaled corticosteroids.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA. salpeter@stanford.edu
authors.forename: Shelley R
authors.initials: SR
authors.lastname: Salpeter
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Wall
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Buckley
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000009:adverse effects*; D001249:Asthma / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D002648:Child; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D016017:Odds Ratio
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents