Stuart W. Stoloff, MD
Potential Financial Conflicts of Interest:Consultancies: AstraZeneca, GlaxoSmithKline, Schering-Plough, Merck & Co. Inc., Aventis, Altana Pharma, Novartis, Genentech; Honoraria: Merck & Co. Inc., AstraZeneca, GlaxoSmithKline, Schering-Plough, Aventis, Altana Pharma.
Stoloff S.; Safety of Long-Acting β-Agonists. Ann Intern Med. 2006;145:707. doi: 10.7326/0003-4819-145-9-200611070-00020
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Published: Ann Intern Med. 2006;145(9):707.
TO THE EDITOR:
The citations listed by Salpeter and colleagues (1) to support their recommendations for the use of anticholinergic agents in both acute asthma exacerbations and chronic asthma are, in fact, quoted inaccurately. Rodrigo and Castro-Rodriguez's 2005 meta-analysis clearly states that “inhaled anticholinergic agents with β2-agonists lead to a reduction in admission rates of both children and adults of 30%” (2). No published papers support anticholinergics as monotherapy in acute asthma. Also, the addition of anticholinergics to β2-agonists treatment provided benefit only to patients with moderate to severe obstruction. Westby and colleagues' 2004 paper (3) did not identify any justification for routinely introducing anticholinergics as add-on treatment for patients whose asthma was not well-controlled with standard therapy. The role of long-term anticholinergics, such as tiotropium bromide, has yet to be established in patients with persistent asthma, and no randomized, controlled trials support this therapy.
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