Shelley R. Salpeter, MD; Thomas M. Ormiston, MD; Edwin E. Salpeter, PhD
Salpeter SR, Ormiston TM, Salpeter EE. Meta-Analysis: Respiratory Tolerance to Regular β2-Agonist Use in Patients with Asthma. Ann Intern Med. 2004;140:802-813. doi: 10.7326/0003-4819-140-10-200405180-00018
Download citation file:
Published: Ann Intern Med. 2004;140(10):802-813.
The regular administration of Î²2-agonists may be associated with the development of tolerance to their effects.
To assess the effect of regular Î²2-agonist use on respiratory function and Î²2-receptor function in asthmatic patients.
Comprehensive searches of the EMBASE, MEDLINE, and CINAHL databases from 1966 to June 2003 and references of identified articles and reviews.
Randomized, placebo-controlled trials that studied at least 1 week of regular Î²2-agonist administration in patients with asthma and did not allow â€œas-neededâ€ Î²2-agonist use in the placebo group.
Outcomes measured in the active treatment and placebo groups were the change in FEV1 in response to treatment and subsequent Î²2-agonist administration, the provocative concentration of bronchoconstrictive agents causing a 20% reduction in FEV1 (PC20), and in vitro variables of leukocyte Î²2-receptor function.
Pooled results of 22 trials showed that regular Î²2-agonist use, compared with placebo, did not change the mean FEV1 after treatment or the net FEV1 treatment effect but substantially reduced the following: the peak FEV1 response to subsequent Î²2-agonist administration (change, âˆ’17.8% [95% CI, âˆ’27.2% to âˆ’8.5%]); the FEV1 dose response to subsequent Î²2-agonists (âˆ’34.8% [CI, âˆ’45.7% to âˆ’24%]); the PC20 to combined bronchoconstrictive stimuli (âˆ’26% [CI, âˆ’37% to âˆ’11%]); and leukocyte Î²2-receptor density (âˆ’18.3% [CI, âˆ’31.6% to âˆ’5.1%]), binding affinity (âˆ’23.1% [CI, âˆ’39.4% to âˆ’6.8%]), and in vitro response to isoproterenol (âˆ’32.7% [CI, âˆ’56.5% to âˆ’9.0%]).
Regular Î²2-agonist use for at least 1 week in patients with asthma results in tolerance to the drug's bronchodilator and nonbronchodilator effects and may be associated with poorer disease control compared with placebo.
Learn more about subscription options.
Register Now for a free account.
Asthma, Pulmonary/Critical Care.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only