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SELECTED ARTICLES FROM THE RECENT LITERATURE 2006
11/30/06
Serious adverse events associated with the use of inhaled long acting beta agonists
Summary
Background - Inhaled long acting beta agonists (LABA) such as salmeterol (Sal) have been used extensively in the chronic maintenance therapy of persistent asthma (PA). However, some studies such as the SMART study have shown an increased incidence of serious worsening of asthma, even fatal asthma, associated with the use of Sal as monotherapy in PA.
Findings - Martinez of the Univ of Arizona reviewed this situation with his point of view. He described 2 possible reasons for the adverse effects associated with Sal therapy: 1) the lack or insufficient use of inhaled corticosteroids (ICS) by patients receiving Sal. However, he feels that there is not definitive evidence that concomitant use of sufficient ICS dosage would prevent worsening of asthma in the patients using Sal chronically; 2) his preferred reason for the adverse effect of Sal is that a small group of asthmatic patients develop idiosyncratic responses to LABA. Variants in genes that encode for proteins associated with pharmacological responses to LABA may be responsible.
Reference
Clin Rev Allergy Immunol 2006;31:269-78
Editor's Comments
This possible adverse consequence of chronic Sal treatment has been a subject of intense recent debate. Martinez, the author of this opinion piece, is firmly on the side of those very concerned about adverse effects of chronic LABA use, at least in a sub-population of asthmatics. He agrees with the decision of the FDA to issue a "black box" warning that LABA should not be used as first line therapy of PA. On the other hand Nelson of the National Jewish Medical and Research Center has argued that the adverse events attributed to chronic LABA therapy was limited to a very small group, particularly African-Americans. The studies noted above were not designed to see if ICS treatment along with LABA was protective.
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