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Safety and Effectiveness of Long-Acting Inhaled β-Agonist Bronchodilators When Taken with Inhaled Corticosteroids

Pierre Ernst, MD; Andrew McIvor, MD; Francine M. Ducharme, MD; Louis-Philippe Boulet, MD; Mark FitzGerald, MB; Kenneth R. Chapman, MD; Tony Bai, MD, Canadian Asthma Guideline Group
[+] Article and Author Information

From McGill University, Montréal, and Université Laval, Quebéc City, Québec, Canada; McMaster University, Hamilton, and University of Toronto, Toronto, Ontario, Canada; and University of British Columbia, Vancouver, British Columbia, Canada.


Potential Financial Conflicts of Interest:Consultancies: P. Ernst (Altana, AstraZeneca, Novartis, Merck, GlaxoSmithKline), A. McIvor (Altana, AstraZeneca, GlaxoSmithKline Canada), F.M. Ducharme (AstraZeneca), L.-P. Boulet (Altana, AstraZeneca, GlaxoSmithKline, Novartis, Merck Frosst), M. FitzGerald (AstraZeneca, GlaxoSmithKline), K.R. Chapman (Altana, AstraZeneca, Biovail, Boehringer-Ingelheim, Genpharm, GlaxoSmithKline, Hoffman-LaRoche, Merck Frosst, Novartis, Pfizer, Schering-Plough, Telacris), T. Bai (GlaxoSmithKline Canada, AstraZeneca Canada); Honoraria: P. Ernst (Altana, AstraZeneca, Merck Frosst, Novartis, GlaxoSmithKline), A. McIvor (Altana, AstraZeneca, GlaxoSmithKline Canada), F.M. Ducharme (GlaxoSmithKline), L.-P. Boulet (3M, Altana, AstraZeneca, GlaxoSmithKline, Merck Frosst, Novartis), M. FitzGerald (AstraZeneca, GlaxoSmithKline), K.R. Chapman (3M, Altana, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck Frosst, Novartis, Pfizer, Telacris); Grants received: P. Ernst (GlaxoSmithKline), F.M. Ducharme (GlaxoSmithKline), L.-P. Boulet (3M, AllerGen, Altana, Asthmatx, AstraZeneca, Boehringer-Ingelheim, Canadian Institutes of Health Research, Dynavax, Fond de Recherche en Santé du Québec, Genentech, GlaxoSmithKline, Institut de Recherche en Santé et Securité au Travail du Québec, IVAX, Merck Frosst, National Institute for Occupational Safety and Health (Centers for Disease Control and Prevention), Novartis, Pfizer, Roche, Québec Asthma and Chronic Obstructive Pulmonary Disease Network (Towards Excellence in Asthma Management), Schering, Topigen), M. FitzGerald, K.R. Chapman (3M, Altana, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, GlaxoSmithKline, Hoffman-LaRoche, Merck Frosst, Novartis, Telacris, Theratechnologies).

Requests for Single Reprints: Andrew McIvor, MD, Firestone Institute for Respiratory Health, St. Joseph's Healthcare, 50 Charlton Avenue E, Room T2127, Hamilton, Ontario L8N 4A6, Canada; e-mail, amcivor@stjosham.on.ca.

Current Author Addresses: Dr. Ernst: McGill University, 687 Pine West, R4-29, Montréal, Québec H3A 1A3, Canada.

Dr. McIvor: Firestone Institute for Respiratory Health, St. Joseph's Healthcare, 50 Charlton Avenue E, Room T2127, Hamilton, Ontario L8N 4A6, Canada.

Dr. Ducharme: McGill University Health Centre, 2300 Tupper, Montréal, Québec H3H 1P3, Canada.

Dr. Boulet: Laval Hospital, 2725 Chemin, Sainte-Foy, Québec G1V 4G5, Canada.

Dr. Fitzgerald: The Lung Centre, Vancouver General Hospital, 7th Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.

Dr. Chapman: University of Toronto, Rome 7E-451, 399 Bathurst Street, Toronto M5T 2S8, Canada.

Dr. Bai: UBC Respiratory Division, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y8, Canada.


Ann Intern Med. 2006;145(9):692-694. doi:10.7326/0003-4819-145-9-200611070-00012
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Long-acting β-agonists are a pillar of therapy for many patients with asthma because they are the preferred add-on therapy to inhaled corticosteroids. However, a recent meta-analysis documented a substantial increase in severe exacerbations requiring hospital admission and life-threatening asthma exacerbations in patients treated with long-acting β-agonists. A careful evaluation of this meta-analysis raises several concerns about its applicability to current practice. Pivotal trials evaluating the benefit of adding long-acting β-agonists to inhaled corticosteroids were not included. The authors of the current paper call for physicians to continue their usual practice of using long-acting β-agonists as adjunctive therapy, as well as for an independent meta-analysis of individual patients using inhaled corticosteroids and long-acting β-agonists concomitantly.

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