Safety of Long-Acting β-Agonists
Authors: Harold S. Nelson, Paul M. Dorinsky
Journal: Annals of Internal Medicine (2006)

Letters7 November 2006Safety of Long-Acting β-AgonistsHarold S. Nelson, MD and Paul M. Dorinsky, MDHarold S. Nelson, MDFrom National Jewish Research and Medical Center, Denver, Colorado, and GlaxoSmithKline, Research Triangle Park, North Carolina. and Paul M. Dorinsky, MDFrom National Jewish Research and Medical Center, Denver, Colorado, and GlaxoSmithKline, Research Triangle Park, North Carolina.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-145-9-200611070-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: Salpeter and colleagues (1) assert that concomitant use of inhaled corticosteroids does not adequately protect against rare adverse events that are associated with long-acting β-agonist (LABA) use. However, their meta-analysis includes only studies in which patients were randomly assigned to LABAs or placebo and nearly 50% of patients were not receiving concomitant inhaled corticosteroids. The authors attempt to control for this limitation by examining studies that reported concomitant inhaled corticosteroid use in more than 75% of patients, but adherence to unblinded inhaled corticosteroid use in those studies is unknown. In addition, all patients reported using inhaled corticosteroids ...References1. Salpeter SR, Buckley NS, Ormiston TM, Salpeter EE. Meta-analysis: effect of long-acting beta-agonists on severe asthma exacerbations and asthma-related deaths. Ann Intern Med. 2006;144:904-12. [PMID: 16754916] LinkGoogle Scholar2. Ni CM, Greenstone IR, Ducharme FM. Addition of inhaled long-acting beta2-agonists to inhaled steroids as first line therapy for persistent asthma in steroid-naive adults. Cochrane Database Syst Rev. 2005;:CD005307. [PMID: 15846751] MedlineGoogle Scholar3. Matz J, Emmett A, Rickard K, Kalberg C. Addition of salmeterol to low-dose fluticasone versus higher-dose fluticasone: an analysis of asthma exacerbations. J Allergy Clin Immunol. 2001;107:783-9. [PMID: 11344343] CrossrefMedlineGoogle Scholar4. Shrewsbury S, Pyke S, Britton M. Meta-analysis of increased dose of inhaled steroid or addition of salmeterol in symptomatic asthma (MIASMA). BMJ. 2000;320:1368-73. [PMID: 10818025] CrossrefMedlineGoogle Scholar5. Masoli M, Weatherall M, Holt S, Beasley R. Moderate dose inhaled corticosteroids plus salmeterol versus higher doses of inhaled corticosteroids in symptomatic asthma. Thorax. 2005;60:730-4. [PMID: 16135679] CrossrefMedlineGoogle Scholar6. Bateman ED, Boushey HA, Bousquet J, Busse WW, Clark TJ, Pauwels RA, et al. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study. Am J Respir Crit Care Med. 2004;170:836-44. [PMID: 15256389] CrossrefMedlineGoogle Scholar7. American Lung Association Epidemiology & Statistics Unit Research and Program Services. Trends in asthma morbidity and mortality. New York: American Lung Association; May 2005. Accessed at www.lungusa.org on 14 June 2006. Google Scholar8. Hoyert DL, Heron MP, Murphy SL, Kung HC. Deaths: final data for 2003. Natl Vital Stat Rep. 2006;54:1-120. [PMID: 16689256] MedlineGoogle Scholar9. Miniño AM, Heron MP, Smith BL. Deaths: preliminary data for 2004. Natl Vital Stat Rep. 2006;54:1-49. [PMID: 16850709] MedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Harold S. Nelson, MD; Paul M. Dorinsky, MDAffiliations: From National Jewish Research and Medical Center, Denver, Colorado, and GlaxoSmithKline, Research Triangle Park, North Carolina.Disclosures: Dr. Nelson is a consultant for Altana Pharma, AstraZeneca, Genentech–Novartis, GlaxoSmithKline, Merck & Co. Inc., and Schering-Plough and is a speaker for AstraZeneca, GlaxoSmithKline, Pfizer Inc., and Schering-Plough. Dr. Dorinsky is an employee of GlaxoSmithKline. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-Analysis: Effect of Long-Acting β-Agonists on Severe Asthma Exacerbations and Asthma-Related Deaths Shelley R. Salpeter , Nicholas S. Buckley , Thomas M. Ormiston , and Edwin E. Salpeter Safety of Long-Acting β-Agonists Mats Jacob Lindberg Safety of Long-Acting β-Agonists Shelley R. Salpeter Safety of Long-Acting β-Agonists Graeme P. Currie Safety of Long-Acting β-Agonists Stuart W. Stoloff Safety of Long-Acting β-Agonists Dermot Ryan Metrics Cited byAirway smooth muscleA novel EST‐derived RNAi screen reveals a critical role for farnesyl diphosphate synthase in β2‐adrenergic receptor internalization and down‐regulationThe Safety of Long‐Acting Beta‐Agonists and the Development of Combination Therapies for Asthma and COPDLiteraturBiochemical Basis of Asthma TherapySafe use of long-acting β-agonists: what have we learnt?NHG-Standaard Astma bij volwassenenSELECTED REFERENCESDifferences in physicians' self-reported knowledge of, attitudes toward, and responses to the black box warning on long-acting β-agonistsNHG-Standaard Astma bij volwassenenThe risk of asthma mortality with inhaled long acting β-agonistsDrugs for airway diseaseβ2-Agonists, Anticholinergics, and Other Nonsteroid DrugsImportance of inhaler devices in the management of airway diseaseSafety of long-acting ??-agonists in asthma: a reviewReview: Safety of long-acting β2 -agonists in the treatment of asthmaCurrent awareness: Pharmacoepidemiology and drug safety 7 November 2006Volume 145, Issue 9Page: 706KeywordsAsthmaDeath ratesHealth statisticsHospitalizationsPatientsSafetyStatistical dataTreatment guidelines ePublished: 7 November 2006 Issue Published: 7 November 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. 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