Is it safe to use long-acting beta-agonists in asthma and chronic obstructive pulmonary disease? Implications of recent trials and meta-analyses.

The safety of long-acting beta-agonists (LABAs) has been hotly debated for several years, with surveillance studies suggesting increased risk of mortality, especially with use of LABA without inhaled corticosteroid (ICS). Meta-analyses of selected trials, especially those dominated by one large study, report significantly increased risks for mortality and Serious Adverse Events (SAEs). Review of all of the available evidence from clinical trials, and meta-analyses using different selection criteria, suggests that LABA with ICS in fact significantly reduces SAEs. The risk of mortality is more difficult to assess, but post-hoc analyses suggest the risk is increased with LABA monotherapy and not with concomitant use of ICS. In both asthma and chronic obstructive pulmonary disease, concomitant use of ICS should be considered best practice whenever LABAs are used.