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Monday, April 26, 2010

Long-acting β2-agonists effective for acute asthma exacerbations

The FDA has just issued an alert not to use long-acting β2 agonists (LABAs) as single control agents for asthma or for the treatment of acute severe asthma. Yet, a few studies show that LABAs, formoterol in particular, may be used in place of short-acting β2 agonists (SABAs) for acute attacks. This is consistent with discussion in the Global Initiative for Asthma guidelines about the possibility that inhaled formoterol might be just as effective as salbutamol for acute intervention. Formoterol has a rapid effect (within 3 minutes) and, unlike SABAs, has 12-hour duration.

In a recent article published in the Annals of Allergy, Asthma, and Immunology (2010; 104:247-252), Rodrigo et al. report the results of meta-analysis on a literature search for treatment interventions for acute asthma attacks that presented to emergency departments. They report that the number of studies was small, but comprised over 500 subjects. The authors found no difference in spirometric measures between formoterol and SABAs across all time points. Importantly, this shared efficacy was independent of dose ratios, age, severity, sponsorship and analysis method. On the other hand, there was no clear physiologic advantage to formoterol, as both formoterol and SABAs had the same effect on serum potassium, heart rate, QT interval and hospitalization.

The authors suggest, in conclusion, that formoterol is equally effective as SABAs for the treatment of acute asthma. They caution that their findings do not extend to life-threatening asthma since none of the studies analyzed included the very severe population.

These findings appear to challenge the recent FDA recommendation.

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