An update on the safety of long-acting beta-agonists in asthma patients using inhaled corticosteroids.
BACKGROUND
Pooled trial data have shown that long-acting beta-agonists increase the risk for asthma hospitalizations and deaths by two to fourfold compared with placebo. Until recently, it was unclear whether concomitant inhaled corticosteroids (ICSs) could eliminate this risk.


METHODS
This review summarizes the available data on the safety of long-acting beta-agonist use in asthma, with and without concomitant ICSs. The results from an updated meta-analysis are presented, with data through December 2008.


RESULTS
In pooled trial data, catastrophic asthma events (defined as asthma-related intubation or death) were increased fourfold for concomitant treatment with long-acting beta-agonists and ICSs compared with corticosteroids alone (odds ratio 3.7; 95% CI 1.4 - 9.6). It is estimated that the addition of long-acting beta-agonists to ICS therapy is associated with an absolute increase of one catastrophic event per 1500 patient-years.


CONCLUSIONS
When the available trial data are pooled together, it is clear that long-acting beta-agonists significantly increase the risk for asthma-related intubations and deaths, even when used in a controlled fashion with concomitant ICSs. Clinical guidelines should readdress the role long-acting beta-agonists have in the management of asthma.
Salpeter
Shelley R
SR
Department of Medicine, Stanford University School of Medicine, California, USA. salpeter@stanford.edu
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000009:adverse effects*; D000818:Animals; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy* / Q000401:mortality; D002986:Clinical Trials as Topic / Q000639:trends; D003692:Delayed-Action Preparations; D006801:Humans
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D003692:Delayed-Action Preparations