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Inhaled Long-Acting ß₂-Agonists in Asthma Treatment

In 2 blinded, randomized U.S. trials, researchers investigated the optimal role of the inhaled long-acting ß₂-agonist salmeterol in the treatment of patients with persistent asthma. Participants received the inhaled corticosteroid triamcinolone (400 µg, twice daily) for 6 weeks, after which they were assigned to 1 of 2 trials, depending on whether they had achieved adequate asthma control.

In one trial, 164 patients with well-controlled asthma received inhaled salmeterol, inhaled triamcinolone, or placebo for 16 weeks. Although some outcomes (e.g., asthma symptoms, use of albuterol, and peak expiratory flow) were similar in the 2 active-treatment groups, triamcinolone recipients experienced significantly fewer treatment failures (6 percent vs. 24 percent) and asthma exacerbations (7 percent vs. 20 percent). Markers of inflammation also were significantly lower in the triamcinolone group.

In the other trial, 175 patients with suboptimal asthma control received inhaled salmeterol (154 patients) or placebo (21), in addition to their triamcinolone dose, for 2 weeks. They maintained these treatments for another 16 weeks; during this time, half of the salmeterol recipients continued their triamcinolone treatment, and the other half and the placebo recipients had their triamcinolone dose reduced by 50 percent for 8 weeks and then eliminated for 8 weeks. During the reduction phase, the rate of treatment failure did not differ significantly between the 2 salmeterol groups; during the elimination phase, however, the treatment failure rate was significantly greater among patients who no longer received triamcinolone (46.3 percent vs. 13.7 percent).

Comment: Based on the results from these studies, inhaled steroids cannot be replaced by long-acting ß₂-agonists in asthma treatment, but inhaled steroid dose can be reduced after addition of a ß₂-agonist. An editorialist cautions that elimination of airway inflammation should be a primary goal of asthma treatment and that the optimal way to combine inhaled long-acting ß₂-agonists with inhaled steroids has not been defined fully.

— WC Taylor

Published in Journal Watch General Medicine July 17, 2001

Citation(s):

Lazarus SC et al. Long-acting ß₂-agonist monotherapy vs continued therapy with inhaled corticosteroids in patients with persistent asthma: A randomized controlled trial. JAMA 2001 May 23 285 2583-2593.

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Lemanske RF et al. Inhaled corticosteroid reduction and elimination in patients with persistent asthma receiving salmaterol: A randomized controlled trial. JAMA 2001 May 23 285 2594-2603.

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Holgate ST. Therapeutic options for persistent asthma. JAMA 2001 May 23 285 2637-2639.

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