Published ahead of print on March 12, 2009, doi:10.1164/rccm.200901-0055CC
© 2009 American Thoracic Society doi: 10.1164/rccm.200901-0055CC
The β-Agonist Saga and Its Clinical Relevance: On and On It Goes1 Dunedin School of Medicine, University of Otago, Dunedin, New Zealand Correspondence and requests for reprints should be addressed to D. Robin Taylor, M.D., F.R.C.P.C., Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. E-mail: robin.taylor{at}stonebow.otago.ac.nz ABSTRACT The decision by the Food and Drug Administration to issue a "black box" warning for long-acting β-agonists has been followed by a series of pharmacoepidemiological studies focusing on the safety of these drugs. However, these provide the clinician with mixed messages and do not offer clear guidance as to whether adverse responses to β-agonists are a relevant consideration in individual patients. Simultaneously, there is a growing body of evidence that continuous or high dose–β-agonist exposure is proinflammatory and that, paradoxically, airway hyperresponsiveness is enhanced, not attenuated. Also, pharmacological theory regarding the pathophysiological function of the β-adrenoceptor is having to be revised. A recent clinical study has even suggested that β-blockers rather than β-agonists may be beneficial in asthma. In practice, there are individuals in whom excessive β-agonist use contributes adversely to poor asthma control. The recommendation that concomitant use of inhaled steroids will obviate any risks associated with β-agonists is not in fact fool-proof. Clinicians need to be aware of how to identify and manage patients for whom β-agonist treatment is a problem rather than a solution. They constitute a small but important subgroup of patients with difficult asthma.
Key Words: adverse effects • beta-agonist • formoterol • long-acting • salmeterol This article has been cited by other articles:
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