SELECTED ARTICLES FROM THE RECENT LITERATURE 2005
12/12/05
Long acting beta agonists in the management of asthma exacerbations
Summary
Background - Inhaled long acting beta agonists (LABA) such as salmeterol and formoterol have a relatively well-defined role in the chronic management of persistent asthma. However the role of LABA is uncertain in acute asthma exacerbations (AAE) in which shorter acting beta agonists such as albuterol are generally used.
Findings - Hospenthal and Peters of the Univ of Texas Health Sciences Center in San Antonio reviewed literature dealing with the use of inhaled LABA in AAE. They pointed out that formoterol, with as rapid an onset of bronchodilatory effect as albuterol (but much longer duration of this effect) has already been approved as an asthma reliever as well as controller medication in Europe. There is emerging evidence supporting use of formoterol for out-patient treatment of mild exacerbations of asthma. Recent studies suggest that salmeterol added to conventional therapy is safe and helpful in patients hospitalized for an AAE.
Reference
Curr Opin Pulm Med 2005;11:69-73
Editor's Comments
Although salmeterol has been in use as an LABA longer than has formoterol, I think that formoterol is a more interesting treatment approach. This is because of its very rapid onset of bronchodilatory effect, as rapidly as albuterol (within 2-3 minutes vs an average onset of 30 minutes for salmeterol). Thus formoterol has more potential for the rapid treatment of AAE. There is a potential concern about using formoterol repeatedly over short time periods in an AAE because of possible cumulative adverse effects over several hours. However, studies have found no difference in the frequency/intensity of adverse effects between formoterol and albuterol (Allergol Immunopathol 2004;32:18-20). Also, the bronchodilatation induced by formoterol 12 hours later was significantly more than seen 12 hours after salmeterol treatment (Ped Allergy Immunol 2004;15:32-39).
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