Long-acting beta2-agonists for chronic asthma in adults and children where background therapy contains varied or no inhaled corticosteroid

Walters EH, Gibson PG, Lasserson TJ, Walters JAE

Summary

In this review of studies in which patients were either not on inhaled corticosteroids, or in which some patients but not all were on inhaled corticosteroids, treatment with regular long-acting beta-2 agonists such as salmeterol (Serevent) or formoterol (Foradil, Oxis) in chronic asthma resulted in fewer asthma symptoms by day or night, less relief bronchodilator medication requirement, better lung function, a lower risk of acute worsening of asthma and better quality of life, but most of the evidence comes from groups in which at least some used inhaled corticosteroid therapy. There is less information on asthma control in patients who did not use a regular 'preventer medication' or in children under twelve years, but the same generally positive effects on symptoms and lung function seem to apply. We have also been particularly focussed on serious adverse events, given previous concerns about potential risks, especially of death, from regular beta-2 agonist use. A significant increase in asthma related deaths or life threatening experiences has been found in a recently published surveillance study, with an increased risk of around one event over 6 months for every thousand patients treated. This increase was mainly in African-Americans and those not on inhaled corticosteroids, although these observations were drawn from analyses conducted after the event (post-hoc) and as such lack the validity of pre-defined distinctions.