Shirin Shafazand, MD, MS, FCCP, D.ABSM, FRCP(c)
In patients with asthma who are taking inhaled corticosteroids (ICSs), is concomitant therapy with long-acting β-agonists (LABAs) safe?
Included studies compared ≥ 12 weeks of therapy with LABAs (formoterol or salmeterol) plus ICSs with ICSs alone in patients with asthma, with blinding of patients and caregivers. Exclusion criteria were < 12 years of age; control patients taking LABAs, short-acting β-agonists, or other asthma medications; and crossover studies. Outcomes included all-cause mortality, asthma-related mortality, asthma-related nonfatal intubation and ventilation, asthma-related nonfatal hospitalization, and asthma-related nonfatal serious adverse events.
MEDLINE, EMBASE/Excerpta Medica, ACP J Club, Cochrane databases, and reference lists were searched from 1966 to April 2008, and authors and drug manufacturers were contacted for randomized controlled trials (RCTs). 62 RCTs (n = 29 401, 8200 patient-y of observation) met the selection criteria: 19 RCTs (n = 12 473) evaluated formoterol, and 43 RCTs (n = 16 928) evaluated salmeterol.
Meta-analysis showed that LABAs plus ICSs did not differ from ICSs alone for all-cause mortality (Table), asthma-related hospitalization (Table), or asthma-related serious adverse events. Asthma-related mortality and asthma-related intubation and ventilation were not assessed because of the low frequency of events.
In patients with asthma who are taking inhaled corticosteroids, concomitant therapy with long-acting β-agonists does not affect asthma-related hospitalization or serious adverse events.
Long-acting β-agonists (LABAs) plus inhaled corticosteroids (ICSs) vs ICSs alone for asthma*
*Abbreviations defined in Glossary. Weighted event rates, RRI, RRR, NNH, NNT, and CI calculated from control event rates and odds ratios in article using a random-effect model.
Shafazand S. Review: Long-acting β-agonists do not increase risk for asthma-related hospitalization in patients taking inhaled corticosteroids. Ann Intern Med. ;150:JC3–5. doi: 10.7326/0003-4819-150-6-200903170-02005
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Published: Ann Intern Med. 2009;150(6):JC3-5.
Asthma, Hospital Medicine, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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