Review: β-agonists increase asthma-related intubations and deaths in patients with asthma

In patients with asthma, do long-acting β-agonists (LABAs) increase risk for asthma-related intubations and deaths?

Included studies compared LABAs with placebo (variable corticosteroid population) or LABA plus inhaled corticosteroids (ICSs) with an equal or higher dose of ICSs alone (concomitant corticosteroid population) in patients with asthma, were ≥ 3-months duration, and reported ≥ 1 asthma-related intubation or death. Outcomes were asthma-related intubations or deaths.

MEDLINE, EMBASE/Excerpta Medica, Cochrane databases, US Food and Drug Administration Web site, clinical trial registries of drug manufacturers, and previous meta-analyses were searched for randomized controlled trials (RCTs) published through December 2008. 12 double-blind RCTs (n = 36 588; mean age 39 y where reported; 55% women) with intention-to-treat analyses met the selection criteria. Total duration of follow-up was 21 343 patient-years.

Meta-analysis showed that LABAs, with variable or concomitant ICSs, increased risk for asthma-related intubations or deaths (Table). Risk was increased for salmeterol (odds ratio [OR] 1.94, 95% CI 1.24 to 3.04) and formoterol (OR 4.81, CI 1.12 to 20.68) and for intubations (OR 1.76, CI 1.08 to 9.55) and deaths (OR 4.03, CI 1.7 to 9.55).

Long-acting β-agonists increase risk for asthma-related intubations or deaths in patients with asthma.