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JACI Highlights - January 2006
Is there a problem with long-acting, inhaled beta-adrenergic agonists?
Long-acting β -agonists provide bronchodilation (expansion of the bronchial air passages) and improve asthma control, according to a study by Nelson and colleagues published in the January 2006 issue of the Journal of Allergy and Clinical Immunology. Regular use is not associated with significant tolerance to their bronchodilator action, impairment in the response to short-acting beta-agonists, decline in baseline pulmonary function, increased response to methacholine or increased risk of adverse cardiac events. Case control studies do not suggest an increased risk for death or intensive care admission with the use of the long-acting b 2 -agonists. In the few prospective studies in which there has been an increase in asthma deaths or serious asthma exacerbations, this increased risk has not been observed in subjects concomitantly employing inhaled corticosteroids. The pattern of severe exacerbations does not suggest a toxic effect of the drug on a subset of asthmatics, rather it appears more likely that a few individuals, with limited access to medical care, experience improvement in asthma symptoms which masks increasing airway inflammation. This results in delay in seeking medical care, resulting in their experiencing a severe exacerbation or even death.
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