title: Formoterol versus short-acting beta-agonists as relief medication for adults and children with asthma.
abstract: BACKGROUND
  Formoterol is a long-acting beta(2)-agonist but because it has a fast onset of action it can also be used as a relief medication.
  
  
  OBJECTIVE
  To asses the efficacy and safety of formoterol as reliever therapy in comparison to short-acting beta(2)-agonists in adults and children with asthma.
  
  
  METHODS
  We searched the Cochrane Airways Group Specialised Register and websites of clinical trial registers (for unpublished trial data), and we checked the Food and Drug Administration (FDA) submissions in relation to formoterol. The date of the most recent search was February 2010.
  
  
  METHODS
  Randomised, parallel-arm trials of at least 12 weeks duration in patients of any age and severity of asthma. Studies randomised patients to any dose of as-needed formoterol versus short-acting beta(2)-agonist. Concomitant use of inhaled corticosteroids or other maintenance medication was allowed, as long as this was not part of the randomised treatment regimen.
  
  
  METHODS
  Two authors independently selected trials for inclusion in the review. Outcome data were extracted by one author and checked by the second author. We sought unpublished data on primary outcomes.
  
  
  RESULTS
  This review includes eight studies conducted in 22,604 participants (mostly adults). Six studies compared formoterol as-needed to terbutaline whilst two studies compared formoterol with salbutamol as-needed. Background maintenance therapy varied across the trials. Asthma exacerbations and serious adverse events showed a direction of treatment effect favouring formoterol, of which one outcome reached statistical significance (exacerbations requiring a course of oral corticosteroids). In patients on short-acting beta(2)-agonists, 117 people out of 1000 had exacerbations requiring oral corticosteroids over 30 weeks, compared to 101 (95% CI 93 to 108) out of 1000 for patients on formoterol as-needed. In patients on maintenance inhaled corticosteroids there were also significantly fewer exacerbations requiring a course of oral corticosteroids on formoterol as-needed (Peto OR 0.75; 95% CI 0.62 to 0.91). There was one death per 1000 people on formoterol or on short-acting beta(2)-agonists.
  
  
  CONCLUSIONS
  In adults, formoterol was similar to short-acting beta(2)-agonists when used as a reliever, and showed a reduction in the number of exacerbations requiring a course of oral corticosteroids. Clinicians should weigh the relatively modest benefits of formoterol as-needed against the benefits of single inhaler therapy and the potential danger of long-term use of long-acting beta(2)-agonists in some patients. We did not find evidence to recommend changes to guidelines that suggest that long-acting beta(2)-agonists should be given only to patients already taking inhaled corticosteroids.There was insufficient information reported from children in the included trials to come to any conclusion on the safety or efficacy of formoterol as relief medication for children with asthma.
authors.affiliation: Population Health Sciences and Education, St George's, University of London, Cranmer Terrace, London, UK, SW17 0RE.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Welsh
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cates
mesh_terms: D000328:Adult; D000367:Age Factors; D000420:Albuterol / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use; D002648:Child; D004205:Cromolyn Sodium / Q000627:therapeutic use; D004983:Ethanolamines / Q000627:therapeutic use*; D000068759:Formoterol Fumarate; D006801:Humans; D017835:Nedocromil / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013726:Terbutaline / Q000627:therapeutic use
chemical_list: D001993:Bronchodilator Agents; D004983:Ethanolamines; D017835:Nedocromil; D019819:Budesonide; D013726:Terbutaline; D004205:Cromolyn Sodium; D000420:Albuterol; D000068759:Formoterol Fumarate
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