Long-acting beta agonists: a risk-benefit profile in patients with asthm

Medicamentos beta-agonistas de larga acción: perfil de riesgo-beneficio en pacientes con asma

Published 2010-06-01

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Vol. 22 No. 2 (2010)
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Revisión de tema
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Long-acting beta agonists: a risk-benefit profile in patients with asthm.
rev. colomb. neumol. [Internet]. 2010 Jun. 1 [cited 2024 Dec. 11];22(2):37-41.
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Rodolfo J Dennis
MD, MSc, PhDc. Director Departamentos de Medicina Interna e Investigaciones, Fundación Cardioinfantil. Profesor Titular de Medicina, Universidad Javeriana. Bogotá, Colombia.
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    There is evidence that patients with asthma exposed to long-acting beta-agonist bronchodilators (LABAs) in whom simultaneous anti-inflammatory treatment with inhaled corticoids (ICS) is not granted may present with events of worsening of their asthma. These events are very infrequent, but severe and potentially fatal. It is not clear whether this finding is due to adverse events associated with the mechanism of action of LABAs or to masking of the severity of the asthma. There is no evidence derived from clinical trials in human beings suggesting that patients exposed to LABAs in whom anti-inflammatory therapy with ICS is simultaneously administered might present with severe, potentially lethal events of worsening of their asthma. There is likewise no conclusive risk-evidence derived from meta-analyses or observational studies. Unfortunately, neither is there conclusive evidence of absence of risk. The judgment of value given to the risk-benefit of LABAs+ICS can vary among physicians, patients, regulators, and epidemiologists. This balance has been widely discussed. There is broad consensus that the balance is in favor of maintaining the availability of combinations of LABAs+ICS for patients with asthma. This review summarizes important recommendations regarding their utilization, based on current evidence.

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    1. Spitzer WO, Suissa S, Ernst P, et al. The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med 1992; 326: 501-6.
    2. Suissa S, Ernst P, Boivin JF, et al. A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am J Respir Crit Care Med 1994; 149: 604-10.
    3. Mullen M, Mullen B, Carey M. The association between betaagonist use and death from asthma. A meta-analytic integration of case-control studies. JAMA 1993; 270: 1.842-5.
    4. Ernst P, Habbick B, Suissa S, et al. Is the association between inhaled beta-agonist use and life-threatening asthma because of confounding by severity? Am Rev Respir Dis 1993; 148: 75-9.
    5. Ernst P, Spitzer WO, Suissa S, et al. Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use. JAMA 1992; 268: 3462-42
    6. Pearlman DS, Chervinsky P, La Force C, et al. A comparison of salmeterol with albuterol in the treatment of mild to moderate asthma. N Engl J Med 1992; 327: 1420-5.
    7. D’Alonzo GE, Nathan RA, Henochowicz S, et al. Salmeterol Xinafoate as Maintenance Therapy Compared With Albuterol in Patients With Asthma. JAMA 1994; 271: 1412-6.
    8. Salpeter SR, Ormiston TM, Salpeter EE. Meta-analysis: respiratory tolerance to regular beta2-agonist use in patients with asthma. Ann Intern Med 2004; 140: 802-13.
    9. Sindi A, Todd DC, Parameswaran M. Anti-inflammatory effects of long-acting beta2-agonists in patients with asthma. Chest 2009; 136: 145-54.
    10. Castle W, Fuller R, Hall J, Palmer J. Serevent nationwide surveillance study. BMJ 1993; 306: 1034-7.
    11. Nelson HS, Weiss ST, Bleecker ER, et al. The salmeterol multicenter research trial. Chest 2006; 129: 15-26.
    12. Meier CR, Jick H. Drug use and pulmonary death rates in increasingly symptomatic asthma patients in the UK. Thorax 1997; 52: 612-7.
    13. Lanes SF, Lanza LL, Wentworth CE. Risk of emergency care, hospitalization, and ICU stays for acute asthma among recipients of salmeterol. Am J Respir Crit Care Med 1998; 158: 857-61.
    14. Williams C, Crossland L, Finnerty J, et al. Case-control study of salmeterol and near-fatal attacks of asthma. Thorax 1998; 53:1-2.
    15. Anderson HR, Ayres JG, Sturdy PM, et al. Bronchodilator treatment and deaths from asthma: case-control study. BMJ 2005; 330: 117.
    16. Drazen JM, O´Byrne PM. Risk of long-acting beta-agonists in achieving asthma control. N Eng J Med 2009; 360: 1671-2.
    17. Wijesinghe M, Weatherall M, Perrin K, et al. International trends in asthma mortality rates in the 5 to 34 year age group. Chest 2009; 135: 1045-9.
    18. Wijesinghe M, Perrin K, Harwood M, et al. The risk of asthma mortality with inhaled long acting beta-agonists. Postgrad Med J 2008; 84: 467-72.
    19. Gyembycz MA, Kaur M, Leight R, et al. A holy grail of asthma management: toward understanding how long acting beta2 adrenoceptor agonists enhance the clinical efficacy of inhaled corticosteroids. Br J Pharmacol 2008; 153: 1090-1104.
    20. Martinez FD. Safety of long-acting beta-agonists: an urgent need to clear the air. N Eng J Med 2005; 353: 2637-2639.
    21. Beasley R, Martinez FD, Hackshaw A, et al. Safety of longacting beta-agonists: urgent need to clear the air remains. Eur Respir J 2009; 33:3-5
    22. Taylor DR. On and on it goes-the beta agonist saga and its clinical relevance. Am J Respir Crit Care Med. 2009; 179:976-8.
    23. Sears MR. Safety of long-acting beta-agonists: are new data really required? Chest 2009; 136: 604-7.
    24. Cates CJ, Cates MJ, Lasserson TJ. Regular treatment with formoterol for chronic asthma: serious adverse events.Cochrane database syst rev 2008 (4): CD006923.
    25. Sears MR, Ottosson R, Radner F et al. Long-acting beta-agonists: a review of formoterol safety data from asthma clinical trials. Eur Respir J 2009; 33: 21-32.
    26. Wijesinghe M, Weatherall M, Perrin K, et al.Risk of mortality associated with formoterol: a systematic review and metaanalysis. Eur Respir J 2009; 34: 803-811.
    27. Nelson H, Bonuccelli C, Radner F, et al. Safety of formoterol in patients with asthma: combined analysis of data from randomized control trials. J Allergy and Clin Inmunol 2010; 125: 390-6.
    28. Cates CJ, Cates MJ, Lasserson TJ. Regular treatment with salmeterol for chronic asthma: serious adverse events. Cochrane database syst rev 2008 (3): CD006363.
    29. Bateman E, Nelson H, Bousquet J, et al. Meta-analysis: effects of adding salmeterol to inhaled corticosteroids on serious asthma-related events. Ann Intern Med 2008; 149: 33-42.
    30. Weatherall M, Wijesinghe M, Perrin K, et al. Meta-analysis of the risk of mortality with salmeterol and the effect of concomitant inhaled corticosteroid therapy. Thorax 2010; 65:39-43.
    31. Salpeter SR, Buckely NS, Ormiston TM, et al. Meta-analysis: effect of long acting beta-agonists on severe asthma exacerbations and asthma related deaths. Ann Intern Med 2006;144: 904-912.
    32. Jaeschke R, O´Byrne PM, Mejza F, et al. The safety of longacting beta-agonists among patients with asthma using inhaled corticosteroids.Am J Respir Crit Care Med 2008; 178: 10091016.
    33. Rodrigo GJ, Plaza V, García L, et al. Safety of regular use of long-acting beta-agonists as monotherapy or added to inhaled corticosteroids in asthma. Pulmonary Pharmacology & Therapeutics 2009;22: 9-19.
    34. Salpeter SR, Wall AJ, Buckley NS. Long-acting beta-agonists with and without inhaled corticosteroids and catastrophic asthma events. Am J Med 2010; 123:322-8.
    35. Pauwels R, Lofdahl CG, Postma DS, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. N Eng J Med 1997; 337: 1405-1411.
    36. Lemanske RF, Sorkness CA, Mauger EA, et al. Inhaled corticosteroid reduction and elimination in patients with persistent asthma receiving salmeterol. JAMA 2001; 285: 2594-2603.
    37. O´Byrne PM, Barnes PJ, Rodriguez R, et al. Low dose inhaled budesonide and formoterol in mild persistent asthma. Am J Respir Crit Care Med 2001; 164: 1392-1397.
    38. Bateman ED, Boushey HA, Bousquet J, et al. Can guidelinedefined asthma control be achieved? The GOAL study. Am J Respir Crit Care Med 2004; 170: 836-844.
    39. Edwards SJ, von Maltzhan R, Naya IP, Harrison T. Budesonide/ formoterol for maintainance and reliever therapy of asthma. Int J Clin Practice 2010; 64: 619-27.
    40. Lemanske RF, Mauger DT, Sorkness CA, et al. Step-up therapy for children with uncontrolled asthma receiving inhaled corticosteroids. N Eng J Med 2010; 362: 975-985.
    41. Dennis RJ, Solarte I, and Rodrigo G. Asthma in adults. Clin Evid (Online). 2010 Jan 21; 2010. pii: 1501.
    42. Ducharme FM, Lasserson TJ, Cates CJ. Long-acting beta2agonists versus antileukotrienes as add-on therapy to inhaled corticosteroids for chronic asthma. The Cochrane library, issue 2, 2008. John Wiley & Sons Ltd. Search date 2006.
    43. Kramer JD. Balancing the benefits and risks of long-acting betaagonists – the influence of values. N Eng J Med 2009; 360:1592-1595.
    44. The American Lung Association Asthma Clinical Research Centers. Randomized comparison of strategies for reducing treatment in mild persistent asthma. N Engl J Med 2007;356:20272039.
    45. Weatherall M, Wijesinghe M, Perrin K, Beasley R. Long-acting beta-agonists and asthma death: how useful are different study designs to evaluate the potential association? J Asthma. 2010;47:434-8.

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