Beta-2 agonists and asthma: still the mainstay of symptomatic treatment

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Author: John Rees
Date: May 18, 1991
From: British Medical Journal(Vol. 302, Issue 6786)
Publisher: BMJ Publishing Group Ltd.
Document Type: Editorial
Length: 1,651 words

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Abstract :

There is much concern among physicians about the use of anti-asthmatic drugs called beta-2 agonists. At a recent meeting among physicians and pharmaceutical manufacturers, it was made clear that, despite serious reservations, these drugs remain the most important treatment for the symptoms of asthma. The beta-2 agonists work by relaxing smooth muscle. During an asthma attack, the tissues lining the airways, become swollen and the flow of air is restricted; beta-2 agonists relax the smooth muscle of the airways and airflow is restored. Beta-2 agonists have other effects, as well, but the contribution of these effects to the therapeutic value is uncertain. Among these other effects are increased clearance of mucus and direct effects on inflammation. Most of the controversy surrounding the use of beta-2 agonists involves uncertainties about the long-term effects of regular use. Generally, these drugs should be used only as needed. Patients with chronic asthma who find themselves needing beta-2 agonists more than once a day should be receiving some sort of anti-inflammatory treatment such as steroids. Physicians are afraid that patients will use beta-2 agonists regularly to prevent symptoms and will not seek the anti-inflammatory treatment they need. Concerns about long-term use of beta-2 agonists have been heightened by the suggestion that a long-acting beta-2 agonist, fenoterol, has been implicated in the death of some asthma patients in New Zealand. The drug is about twice as powerful as a standard inhaler. It may be that physicians have been inclined to prescribe fenoterol to patients with more serve illness to begin with. There is also some concern that the long-term use of beta-2 agonists might increase the sensitivity of the airways to allergens such as pollen. This has not yet been conclusively demonstrated, but if this is true, then interrupting beta-2 agonist treatment could result in a serious asthma attack. The general consensus is that long-acting beta-2 agonists should be prescribed only for those patients with serious asthma who are already receiving anti-inflammatory treatment in the form of inhaled corticosteroids. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Gale Document Number: GALE|A10825565