The Medical Letter on Drugs and Therapeutics
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Long-Acting Beta-2 Agonists in Asthma

Continued use of a long-acting beta-2 agonist for treatment of asthma may cause down-regulation of the beta-2 receptor with loss of the bronchoprotective effect from rescue therapy with a short-acting beta-2 agonist. After a large study (SMART) found an increased risk of asthma-related deaths in patients receiving the long-acting beta-2 agonist salmeterol,1 a boxed warning was added to the labeling of all medications containing a long-acting beta-2 agonist. Now the FDA has completed a meta-analysis of 110 asthma treatment studies in 60,954 patients taking any of the long-acting beta-2 agonist formulations listed in the table.

RESULTS OF META-ANALYSIS – Overall, use of a long-acting beta-2 agonist was associated with an increased risk of a composite endpoint of asthmarelated death, intubation or hospitalization; the highest risk was in children 4-11 years old. There was no significant increase in risk ... more      

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