Long-acting β2-agonists in the management of asthma exacerbations

Abstract

Asthma exacerbations are a major cause of morbidity in the United States. Although long-acting beta2-agonists have a defined role in maintenance therapy, their potential use in exacerbations remains largely undetermined. This paper reviews recent literature on long-acting beta2-agonists in the context of the management of acute asthma. Although clinical experience with long-acting beta2-agonists now approaches 20 years, their applicability in asthma exacerbations has only recently been explored. Formoterol, with a rapid onset of action similar to albuterol, has already been approved in Europe as a reliever medication and there are emerging data to support its use in the outpatient management of mild exacerbations of asthma. Salmeterol added to conventional therapy has been found to be safe and potentially beneficial in patients hospitalized for an exacerbation. Long-acting beta2-agonists have proved to be useful in the chronic management of asthma and the prevention of exacerbations. Recent data suggest a role for patient-guided management using adjustable dosing of long-acting beta2-agonists with inhaled corticosteroids during periods of worsening asthma. Further research to evaluate the potential role of long-acting beta2-agonists in the management of acute asthma is needed.