Review: long acting {beta} agonists increase severe asthma exacerbations and asthma related deaths in children and adults

doi:10.1136/ebm.12.1.10

Evidence-Based Medicine 2007;12:10; doi:10.1136/ebm.12.1.10

Therapeutics

Review: long acting ß agonists increase severe asthma exacerbations and asthma related deaths in children and adults

Salpeter SR, Buckley NS, Ormiston TM, et al. Meta-analysis: effect of long-acting beta-agonists on severe asthma exacerbations and asthma-related deaths. Ann Intern Med 2006;144:904–2.[Medline]

Q In children and adults with asthma, do long acting ß agonists (LABAs) increase severe asthma exacerbations requiring hospital admission, life threatening asthma attacks, and asthma related deaths?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Internal medicine $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Allergy & immunology $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Emergency medicine $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Respirology $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$

Key Words: adrenergic ß agonists • antiasthmatic agents • asthma • hospital admission

The first 150 words of the full text of this article appear below.

METHODS

Data sources: Medline, EMBASE/Excerpta Medica, CINAHL, and Cochrane databases(all from 1966 to December 2005); references of selected reviews;and the US Food and Drug Administration website.

Study selection and assessment: randomised controlled trials (RCTs) in any language that comparedLABAs (salmeterol, formoterol, or eformoterol) with placeboand had $>=$ 3 month follow up. Patients were allowed to use shortacting ß agonists if needed. 19 RCTs (n = 33 826;mean age 37–38 y, 51% men) met the selection criteria.Quality assessment of individual studies was based on randomisationprocedure, allocation concealment, blinding, dropouts and withdrawals,and intention to treat analysis.

Outcomes: hospital admission for asthma exacerbations, life threateningasthma exacerbations, and asthma related death.

MAIN RESULTS

More patients in the LABA group than in the placebo group werehospitalised for asthma exacerbations, had life threateningasthma exacerbations, or died from asthma (table). Subgroupanalyses showed that increased hospital admission occurred . . . [Full text of this article]

Brian J Smith, MBBS, FRACP, PhD, Anil Roy, MBBS, MD

Queen Elizabeth Hospital, Woodville South, Australia

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