Department of Medicine, Stanford University School of Medicine, California, USA.
Expert Opin Drug Saf. 2010 May;9(3):407-19. doi: 10.1517/14740330903535852.
Pooled trial data have shown that long-acting beta-agonists increase the risk for asthma hospitalizations and deaths by two to fourfold compared with placebo. Until recently, it was unclear whether concomitant inhaled corticosteroids (ICSs) could eliminate this risk.
This review summarizes the available data on the safety of long-acting beta-agonist use in asthma, with and without concomitant ICSs. The results from an updated meta-analysis are presented, with data through December 2008.
In pooled trial data, catastrophic asthma events (defined as asthma-related intubation or death) were increased fourfold for concomitant treatment with long-acting beta-agonists and ICSs compared with corticosteroids alone (odds ratio 3.7; 95% CI 1.4 - 9.6). It is estimated that the addition of long-acting beta-agonists to ICS therapy is associated with an absolute increase of one catastrophic event per 1500 patient-years.
When the available trial data are pooled together, it is clear that long-acting beta-agonists significantly increase the risk for asthma-related intubations and deaths, even when used in a controlled fashion with concomitant ICSs. Clinical guidelines should readdress the role long-acting beta-agonists have in the management of asthma.
汇总试验数据表明，与安慰剂相比，长效β激动剂使哮喘住院和死亡的风险增加了两到四倍。直到最近，是否同时使用吸入皮质类固醇（ICS）可以消除这种风险还不清楚。
这篇综述总结了关于长效β激动剂在哮喘中的安全性的现有数据，无论是否同时使用 ICS。介绍了最新荟萃分析的结果，数据截止到 2008 年 12 月。
汇总试验数据显示，与单独使用皮质类固醇相比，同时使用长效β激动剂和 ICS 的患者发生灾难性哮喘事件（定义为哮喘相关插管或死亡）的风险增加了四倍（比值比 3.7；95%置信区间 1.4-9.6）。据估计，将长效β激动剂添加到 ICS 治疗中与每 1500 患者年发生一次灾难性事件的绝对增加相关。
当汇总可用的试验数据时，很明显，长效β激动剂即使以受控方式与 ICS 同时使用，也会显著增加哮喘相关插管和死亡的风险。临床指南应重新考虑长效β激动剂在哮喘管理中的作用。
