What are safety concerns regarding the use of long-acting beta2-agonist in the treatment of pediatric asthma?

Updated: Jan 08, 2019
  • Author: Girish D Sharma, MD, FCCP, FAAP; Chief Editor: Kenan Haver, MD  more...
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Concerns about the safety of long-acting beta2-agonists and resultant drug safety communications create a question as to the course of treatment if asthma is not controlled by inhaled corticosteroids. [51] A study by Lemanske et al addressed this question and concluded that addition of long-acting beta2-agonist was more likely to provide the best response than either inhaled corticosteroids or leukotriene-receptor antagonists. [52] Asthma therapy should be regularly monitored and adjusted accordingly.

The CHASE (ChildHood Asthma Safety and Efficacy) international clinical trial further evaluated the combination of inhaled corticosteroids plus long-acting beta2 agonists. Orally inhaled budesonide/formoterol (Symbicort) 80/4.5 mcg with orally inhaled budesonide 80 mcg in pediatric patients with asthma aged 6-12 years who were symptomatic on low-dose inhaled corticosteroids. A statistically significant improvement in lung function (FEV1 at 1 h postdose) was observed with the children randomized to budesonide/formoterol (n=92) compared with budesonide alone (n=95) (p ≤0.005). [53]

A systematic review of 18 placebo-controlled clinical trials evaluating monotherapy with inhaled corticosteroids supports their safety and efficacy in children with asthma. [54] In addition, the data provide new evidence linking inhaled corticosteroids use in children with asthma to improved asthma control. A recent study to assess the effectiveness of an inhaled corticosteroid used as rescue treatment recommends that children with mild persistent asthma should not be treated with rescue albuterol alone and the most effective treatment to prevent exacerbations is daily inhaled corticosteroids. This study suggests that inhaled corticosteroids as rescue medication with albuterol might be an effective step down strategy for children as it is more effective at reducing exacerbations than is use of rescue albuterol alone. [55] .

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