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      Inhaled β 2-agonists in asthma management: an evolving story

      research-article
      Author(s): 1 , 2 , 3 , 4 ,
      Publication date (Print):
      Journal: Breathe
      Publisher: European Respiratory Society

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          Abstract

          Sympathomimetic agents have been known in Chinese medicine for at least 5000 years as a drug to treat disorders of respiratory tract; however, they were introduced to western medicine mainly in the beginning of the 20th century [1].

          Abstract

          The history and the future of inhaled β 2-agonists in asthma management http://ow.ly/s1s4305l4k4

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          Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group.

          R A Pauwels, C Löfdahl, D. S. Postma … (1997)
          The role of long-acting, inhaled beta2-agonists in treating asthma is uncertain. In a double-blind study, we evaluated the effects of adding inhaled formoterol to both lower and higher doses of the inhaled glucocorticoid budesonide. After a four-week run-in period of treatment with budesonide (800 microg twice daily), 852 patients being treated with glucocorticoids were randomly assigned to one of four treatments given twice daily by means of a dry-powder inhaler (Turbuhaler): 100 microg of budesonide plus placebo, 100 microg of budesonide plus 12 microg of formoterol, 400 microg of budesonide plus placebo, or 400 microg of budesonide plus 12 microg of formoterol. Terbutaline was permitted as needed. Treatment continued for one year; we compared the frequency of exacerbations of asthma, symptoms, and lung function in the four groups. A severe exacerbation was defined by the need for oral glucocorticoids or a decrease in the peak flow to more than 30 percent below the base-line value on two consecutive days. The rates of severe and mild exacerbations were reduced by 26 percent and 40 percent, respectively, when formoterol was added to the lower dose of budesonide. The higher dose of budesonide alone reduced the rates of severe and mild exacerbations by 49 percent and 37 percent, respectively. Patients treated with formoterol and the higher dose of budesonide had the greatest reductions -- 63 percent and 62 percent, respectively. Symptoms of asthma and lung function improved with both formoterol and the higher dose of budesonide, but the improvements with formoterol were greater. In patients who have persistent symptoms of asthma despite treatment with inhaled glucocorticoids, the addition of formoterol to budesonide therapy or the use of a higher dose of budesonide may be beneficial. The addition of formoterol to budesonide therapy improves symptoms and lung function without lessening the control of asthma.
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            The Salmeterol Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol.

            Scott Weiss, Steven Yancey, Eugene R. Bleecker … (2005)
            To compare the safety of salmeterol xinafoate or placebo added to usual asthma care. A 28-week, randomized, double-blind, placebo-controlled, observational study. Study subjects were seen once in the study physician's office for screening and were provided all blinded study medication for the entire study period. Follow-up by telephone was scheduled every 4 weeks. Subjects (> 12 years old) with asthma as judged by the study physician were eligible. Individuals with a history of long-acting beta2-agonist use were excluded. Salmeterol, 42 mug bid via metered-dose inhaler (MDI), and placebo bid via MDI. Following an interim analysis in 26,355 subjects, the study was terminated due to findings in African Americans and difficulties in enrollment. The occurrence of the primary outcome, respiratory-related deaths, or life-threatening experiences was low and not significantly different for salmeterol vs placebo (50 vs 36; relative risk [RR] = 1.40; 95% confidence interval [CI], 0.91 to 2.14). There was a small, significant increase in respiratory-related deaths (24 vs 11; RR, 2.16; 95% CI, 1.06 to 4.41) and asthma-related deaths (13 vs 3; RR, 4.37; 95% CI, 1.25 to 15.34), and in combined asthma-related deaths or life-threatening experiences (37 vs 22; RR, 1.71; 95% CI, 1.01 to 2.89) in subjects receiving salmeterol vs placebo. The imbalance occurred largely in the African-American subpopulation: respiratory-related deaths or life-threatening experiences (20 vs 5; RR, 4.10; 95% CI, 1.54 to 10.90) and combined asthma-related deaths or life-threatening experiences (19 vs 4; RR, 4.92; 95% CI, 1.68 to 14.45) in subjects receiving salmeterol vs placebo. For the primary end point in the total population, there were no significant differences between treatments. There were small, but statistically significant increases in respiratory-related and asthma-related deaths and combined asthma-related deaths or life-threatening experiences in the total population receiving salmeterol. Subgroup analyses suggest the risk may be greater in African Americans compared with Caucasian subjects. Whether this risk is due to factors including but not limited to a physiologic treatment effect, genetic factors, or patient behaviors leading to poor outcomes remains unknown.
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              Differentiation of receptor systems activated by sympathomimetic amines.

              A M Lands, Richard Ludueña, Matthew Brown … (1967)
              Article 0 comments Cited 86 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Breathe (Sheff)
                Journal ID (iso-abbrev): Breathe (Sheff)
                Journal ID (publisher-id): BREATHE
                Journal ID (hwp): breathe
                Title: Breathe
                Publisher: European Respiratory Society
                ISSN (Print): 1810-6838
                ISSN (Electronic): 2073-4735
                Publication date (Print): December 2016
                Volume: 12
                Issue: 4
                Pages: 375-377
                Affiliations
                [1 ]Serviço de Imunoalergologia, Centro Hospitalar São João, EPE, Porto, Portugal
                [2 ]Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal
                [3 ]Allergology, CUF Porto Hospital and Instituto, Porto, Portugal
                [4 ]CINTESIS – Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Porto, Portugal
                Author notes
                Article
                Publisher ID: EDU-0171-2016
                DOI: 10.1183/20734735.017116
                PMC ID: 5297952
                SO-VID: 0568f5c8-5733-4c4a-a5a9-f3af3c88236a
                Copyright © ©ERS 2016
                License:

                Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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                Categories
                Subject: Expert Opinion
                Subject: Landmarks Papers in Respiratory Medicine
                Subject: 2

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