Regular treatment with long acting beta agonists versus daily regular treatment with short acting beta agonists in adults and children with stable asthma

Walters EH, Walters JAE, Gibson PG

Published Online:

January 21, 2009

Patients with chronic asthma are generally treated with a 'preventer medication' to reduce the underlying airways inflammation but often require bronchodilators for their symptoms. Treatment with regular long acting Beta-agonist bronchodilator agents, such as salmeterol (Serevent) or formoterol (Foradil, Oxis), leads to fewer asthma symptoms during the day and the night, less bronchodilator medication requirement for symptoms, better lung function measurements and better quality of life measurements compared to short acting Beta-agonist bronchodilators such as salbutamol (Ventolin, Asmol, Airomir) or terbutaline (Bricanyl). There were no major adverse effects but there is little information on the effects in patients who do not use a 'preventer medication'.

Abstract (click to read)

Background:

Selective beta-adrenergic agonists for use in asthma are: short acting (2 to 6 hours) and long acting (> 12 hours). There has been little controversy about using short acting beta-agonists intermittently, but long acting beta-agonists are used regularly, and their regular use has been controversial.

Objectives:

To determine the benefit or detriment of treatment with regular short- or long acting inhaled beta-agonists in chronic asthma.

Search strategy:

We carried out a search using the Cochrane Airways Group trial register. We searched bibliographies of identified RCTs for additional relevant RCTs and contacted authors of identified RCTs for other published and unpublished studies.

Selection criteria:

All randomised studies of at least two weeks duration, comparing a long acting inhaled beta-agonist given twice daily with any short acting inhaled beta-agonist of equivalent bronchodilator effectiveness given regularly in chronic asthma.

Data collection and analysis:

Two reviewers performed data extraction and study quality assessment independently. We contacted authors of studies for missing data.

Main results:

Thirty one studies met the inclusion criteria, 24 of parallel group and seven cross over design. Salmeterol xinafoate was used as long acting agent in 22 studies and formoterol fumarate in nine.

Salbutamol was the short acting agent used in 27 studies and terbutaline in five. The treatment period was over two weeks in 29 studies, and at least 12 weeks in 20.

25 studies permitted a variety of co-intervention treatments, usually inhaled corticosteroid or cromones. One study did not permit inhaled corticosteroid.

Long acting beta-agonists were significantly better than short acting for a variety of lung function measurements including morning highest forced expiratory flow measured with a peak flow meter (PEF) (Weighted Mean Difference (WMD) 33 L/min 95% CI 25 to 42) or evening PEF (WMD 26 L/min 95% CI 18 to 33); and had significantly lower scores for day and night time asthma symptom scores and percentage of days and nights without symptoms. They were also associated with a significantly lower use of rescue medication both during the day and night. Risk of exacerbations was not different between the two types of agent, but most studies were of short duration which limits the power to test for such differences.

Authors' conclusions:

Long acting inhaled beta-agonists have advantages across a wide range of physiological and clinical outcomes for regular treatment.

This record should be cited as:

Walters EH, Walters JAE, Gibson PG. Regular treatment with long acting beta agonists versus daily regular treatment with short acting beta agonists in adults and children with stable asthma. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD003901. DOI: 10.1002/14651858.CD003901

Assessed as up to date:

April 24, 2002

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Primary Review Group:

Airways Group

Asthma topics:

Treating with Medications > Chronic Asthma > Beta-agonists, long-acting

Treating with Medications > Chronic Asthma > Beta-agonists, short-acting

Health topics:

Lungs & airways > Asthma (chronic) > Bronchodilators

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Regular treatment with long acting beta agonists versus daily regular treatment with short acting beta agonists in adults and children with stable asthma

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