Controversies Regarding Long-acting β2-agonists

Reena Khianey; John Oppenheimer


Curr Opin Allergy Clin Immunol. 2011;11(4):345-354. 

In This Article

Abstract and Introduction


Purpose of review This review examines the literature regarding the efficacy and safety of long-acting β2-agonists as add-on therapy to inhaled corticosteroids.
Recent findings The Global Initiative for Asthma (GINA) 2009 guidelines and the National Heart, Lung, and Blood Institute (NHLBI) 2007 asthma guidelines recommend adding long-acting β2-agonists to patients inadequately controlled on inhaled corticosteroids. These recommendations must be balanced against published data which demonstrate a signal of increased morbidity and mortality with use of long-acting β2-agonists. These conflicting data raise the question of whether or not there may be genotypic or phenotypic discriminators leading to disparate responses to long-acting β2-agonists.
Summary The combination of long-acting β2-agonists and inhaled corticosteroids demonstrates improvement in asthma control and exacerbation rates; however, long-acting β2-agonists are not recommended for use as monotherapy or without optimization of inhaled corticosteroid dose. Although the majority of asthmatic patients appear to benefit from the addition of long-acting β2-agonists, there are concerns that a small proportion of patients, including steroid-naïve patients and African Americans, may not obtain such benefits. Thus far, studies have not clearly demonstrated genotypic or phenotypic differences explaining the variability in response.


Asthma is a chronic disease characterized by airway inflammation, bronchial hyper-responsiveness, and airway remodeling.[1] The burden of asthma has been increasing over the past two decades.[2] For example, in 2003, 17 per 10 000 people were hospitalized for asthma and 1.4 per 100 000 people died from asthma in the US.[2,3] These sobering figures have resulted in modifications to the NHLBI and GINA asthma management guidelines.[1,4] Although long-acting β2-agonists (LABAs) have been used in conjunction with inhaled corticosteroids (ICS) for many years, safety concerns have prompted the Food and Drug Administration (FDA) to issue official warnings for the use of LABAs.[5,6] In this review, we will explore the literature that addresses both the efficacy and safety of using LABAs in asthmatic patients.


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