Abstract
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.
MeSH terms
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Adrenal Cortex Hormones / administration & dosage
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Adrenal Cortex Hormones / adverse effects
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Adrenal Cortex Hormones / therapeutic use
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Adrenergic beta-2 Receptor Agonists / administration & dosage
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Adrenergic beta-2 Receptor Agonists / adverse effects
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Adrenergic beta-2 Receptor Agonists / therapeutic use*
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Albuterol / administration & dosage
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Albuterol / adverse effects
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Albuterol / analogs & derivatives
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Albuterol / therapeutic use
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Anti-Asthmatic Agents / administration & dosage
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Anti-Asthmatic Agents / adverse effects
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Anti-Asthmatic Agents / therapeutic use*
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Asthma / drug therapy*
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Asthma / ethnology
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Asthma / mortality
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Black or African American
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Cross-Over Studies
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Delayed-Action Preparations
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Double-Blind Method
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Drug Interactions
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Drug Therapy, Combination
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Ethanolamines / administration & dosage
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Ethanolamines / adverse effects
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Ethanolamines / therapeutic use
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Formoterol Fumarate
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Genotype
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Humans
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Inflammation / diagnosis
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Meta-Analysis as Topic
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Multicenter Studies as Topic
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Phenotype
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Polymorphism, Single Nucleotide
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Randomized Controlled Trials as Topic
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Receptors, Adrenergic, beta-2 / genetics
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Receptors, Glucocorticoid / drug effects
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Salmeterol Xinafoate
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Treatment Outcome
Substances
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Adrenal Cortex Hormones
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Adrenergic beta-2 Receptor Agonists
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Anti-Asthmatic Agents
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Delayed-Action Preparations
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Ethanolamines
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Receptors, Adrenergic, beta-2
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Receptors, Glucocorticoid
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Salmeterol Xinafoate
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Albuterol
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Formoterol Fumarate