title: Concerns with beta2-agonists in pediatric asthma - a clinical perspective.
abstract: Beta2-adrenoreceptor agonists (β2-agonists) are extensively used in the treatment of childhood asthma. However, there have been concerns regarding their adverse effects and safety. In 2005, the FDA commissioned a "Black Box Warning" communicating the potential for an increased risk for serious asthma exacerbations or asthma related deaths, with the regular use of LABAs. In a meta-analysis of controlled clinical trials, the incidence of severe adverse events appeared to be highest in the 4-11 year age group. Several mechanisms have been proposed regarding the risk of regular use of β2-agonists, such as masking patients' perception of worsening asthma, desensitization and downregulation of the β2-adrenoreceptor, pro-inflammatory effects of β2-agonists, pharmacogenetic effects of β2-adrenoreceptor polymorphisms and age related differences in pathophysiology of asthma. In this paper, we review β2-receptor pharmacology, discuss the concerns regarding treatment with β2-agonists in childhood asthma, and provide suggestions for clinical pediatric practice in the light of current literature.
authors: University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, GRIAC research institute, PO Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: e.t.g.kersten@umcg.nl.
authors: Elin T G
authors: ET
authors: Kersten
authors: University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, GRIAC research institute, PO Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: g.h.koppelman@umcg.nl.
authors: Gerard H
authors: GH
authors: Koppelman
authors: Department of Pediatrics, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands. Electronic address: b.j.thio@mst.nl.
authors: Bernard J
authors: BJ
authors: Thio
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015536:Down-Regulation; D004348:Drug Labeling; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D009026:Mortality; D000071184:Pharmacogenomic Variants; D018343:Receptors, Adrenergic, beta-2 / Q000235:genetics; D000068299:Salmeterol Xinafoate / Q000009:adverse effects
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D018343:Receptors, Adrenergic, beta-2; D000068299:Salmeterol Xinafoate
keywords: Asthma; Genetic polymorphisms; Tolerance; β2-agonists