Meta-Analysis: Effect of Long-Acting {beta}-Agonists on Severe Asthma Exacerbations and Asthma-Related Deaths -- Salpeter et al., -- Annals of Internal Medicine:
Background: Long-acting ß-agonists may increase the risk for fatal and nonfatal asthma exacerbations.Technorati Tags: asthma, annals of internal medicine, advair, serevent
Purpose: To assess the risk for severe, life-threatening, or fatal asthma exacerbations associated with long-acting ß-agonists...
Study Selection: Randomized, placebo-controlled trials that lasted at least 3 months and evaluated long-acting ß-agonist use in patients with asthma. All trials allowed the use of as-needed short-acting ß-agonists...
Data Synthesis: Pooled results from 19 trials with 33 826 participants found that long-acting ß-agonists increased exacerbations requiring hospitalization (OR, 2.6 [95% CI, 1.6 to 4.3]) and life-threatening exacerbations (OR, 1.8 [CI, 1.1 to 2.9]) compared with placebo. Hospitalizations were statistically significantly increased with salmeterol (OR, 1.7 [CI, 1.1 to 2.7]) and formoterol (OR, 3.2 [CI, 1.7 to 6.0]) and in children (OR, 3.9 [CI, 1.7 to 8.8]) and adults (OR, 2.0 [CI, 1.1 to 3.9]). The absolute increase in hospitalization was 0.7% (CI, 0.1% to 1.3%) over 6 months. The risk for asthma-related deaths was increased (OR, 3.5 [CI, 1.3 to 9.3]), with a pooled risk difference of 0.07% (CI, 0.01% to 0.1%)...