STATE OF THE ART IN β₂‐AGONIST THERAPY: A SAFETY REVIEW OF LONG‐ACTING AGENTS

SUMMARY Despite concerns in the 1970s and 1980s about the safety of short‐acting β 2 ‐agonists, it is now generally accepted that these agents, used at appropriate doses, provide safe and effective treatment for asthma symptoms. After their introduction, β 2 ‐agonists with a long duration of action — formoterol and salmeterol — became widely used as maintenance therapy with inhaled corticosteroids (ICS). Both β 2 ‐agonists are well tolerated in long‐term studies, with no reduction in lung function observed over time, indicating a lack of clinically relevant tolerance development in patients with asthma and COPD. High‐dose studies have indicated that formoterol produces systemic effects of similar duration to, but less pronounced than, salbutamol and terbutaline. Formoterol produces long‐lasting bronchoprotection against exercise‐induced bronchoconstriction, even in patients receiving regular maintenance therapy; its fast onset of effect (similar to salbutamol) allows formoterol to be used as a reliever. Clinically the safety of formoterol and salmeterol has been demonstrated in several studies, both with ICS and alone. ( Int J Clin Pract 2003; 57(8): 689–697)