title: The safety of long-acting beta-agonists: more evidence is needed.
abstract: There is controversy regarding the possibility that long-acting beta-agonists (LABA) may paradoxically contribute adversely to asthma mortality. While studies and meta-analyses indicate increased risk, epidemiological data indicate a slow fall in asthma mortality since the introduction of LABA. Advocates for LABA propose that mandatory simultaneous use of inhaled corticosteroids satisfactorily reduce any potential risk. In the face of lingering doubts, others propose that LABA should be withdrawn from use. In this pro-con article, Kazani et al. provide the rationale for a modified randomized controlled trial that would define the level of risk more clearly, and provide the basis for a clear judgment to be made. Sears argues that current knowledge about the risks associated with LABA, especially when prescribed as monotherapy, provides sufficient evidence for clinicians and licensing authorities alike, and that the logistics and likely outcomes for a large prospective study are unjustified.
authors.affiliation: Division Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. skazani@partners.org
authors.forename: Shamsah
authors.initials: S
authors.lastname: Kazani
authors.forename: James H
authors.initials: JH
authors.lastname: Ware
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Drazen
authors.forename: D Robin
authors.initials: DR
authors.lastname: Taylor
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Sears
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents