title: Controversies regarding long-acting β2-agonists.
abstract: OBJECTIVE
  This review examines the literature regarding the efficacy and safety of long-acting β2-agonists as add-on therapy to inhaled corticosteroids.
  
  
  RESULTS
  The Global Initiative for Asthma (GINA) 2009 guidelines and the National Heart, Lung, and Blood Institute (NHLBI) 2007 asthma guidelines recommend adding long-acting β2-agonists to patients inadequately controlled on inhaled corticosteroids. These recommendations must be balanced against published data which demonstrate a signal of increased morbidity and mortality with use of long-acting β2-agonists. These conflicting data raise the question of whether or not there may be genotypic or phenotypic discriminators leading to disparate responses to long-acting β2-agonists.
  
  
  CONCLUSIONS
  The combination of long-acting β2-agonists and inhaled corticosteroids demonstrates improvement in asthma control and exacerbation rates; however, long-acting β2-agonists are not recommended for use as monotherapy or without optimization of inhaled corticosteroid dose. Although the majority of asthmatic patients appear to benefit from the addition of long-acting β2-agonists, there are concerns that a small proportion of patients, including steroid-naïve patients and African Americans, may not obtain such benefits. Thus far, studies have not clearly demonstrated genotypic or phenotypic differences explaining the variability in response.
authors.affiliation: UMDNJ-New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Reena
authors.initials: R
authors.lastname: Khianey
authors.forename: John
authors.initials: J
authors.lastname: Oppenheimer
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001741:Black or African American; D000420:Albuterol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000068759:Formoterol Fumarate; D005838:Genotype; D006801:Humans; D007249:Inflammation / Q000175:diagnosis; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic; D010641:Phenotype; D020641:Polymorphism, Single Nucleotide; D016032:Randomized Controlled Trials as Topic; D018343:Receptors, Adrenergic, beta-2 / Q000235:genetics; D011965:Receptors, Glucocorticoid / Q000187:drug effects; D000068299:Salmeterol Xinafoate; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents; D003692:Delayed-Action Preparations; D004983:Ethanolamines; D018343:Receptors, Adrenergic, beta-2; D011965:Receptors, Glucocorticoid; D000068299:Salmeterol Xinafoate; D000420:Albuterol; D000068759:Formoterol Fumarate