Regular treatment with formoterol and an inhaled corticosteroid versus regular treatment with salmeterol and an inhaled corticosteroid for chronic asthma: serious adverse events

Abstract

the seven identified studies in adults did not show any significant difference in safety between formoterol and budesonide in comparison with salmeterol and fluticasone. Asthma-related serious adverse events were rare, and there were no reported asthma-related deaths. There was a single small study comparing formoterol and beclomethasone to salmeterol and fluticasone in adults, but no serious adverse events occurred in this study. No studies were found in children. Overall there is insufficient evidence to decide whether regular formoterol and budesonide or beclomethasone have equivalent or different safety profiles from salmeterol and fluticasone.

Cardiovascular safety of new inhaled medications for asthma and chronic obstructive pulmonary disease: a critical review from pharmacist perspective

“…Regular use of beta-2 agonists causes desensitisation and down-regulation of cardiac beta-2 receptors, which leads to worsening of disease. 17,18,23 In contrast, individuals without HF would have normal beta-1 receptors, hence beta-2 receptors have a minor role in setting the HR and contractility. 17 In addition, SABA use was also associated with other cardiovascular AEs.…”

“…fenoterol) was found associated with increased asthma mortality. 18 A long-term study in 2006 has also identified increased asthma related death with the use of salmeterol. 9,31,32 Consequently, LABA is only recommended for use in combination with corticosteroids, especially among asthma patients.…”

“…9,31,32 Consequently, LABA is only recommended for use in combination with corticosteroids, especially among asthma patients. 3,5,9,18,26,29,31,33 In addition, ongoing concerns about the safety and its use in children has prompted the FDA to require more safety studies from drug companies, including 5 double blinded (DB) randomised controlled trial (RCT) by 2017. 34,35 Within the last few years, studies examined the utilisation of inhaled corticosteroids (ICS)+LABAs (salmeterol and efomoterol) in adult asthma patients and observed no significant increase in cardiovascular AEs, including electrocardiogram (ECG) changes, vital signs, and laboratory variables.…”

“…17 Studies found that this can lead to diminished response to beta-2 agonists and increased risk of asthma-related deaths, particularly among individuals with genetic risk factor such as Arg16 genotype on the ADRB2 gene. [18][19][20] Furthermore, some data suggests that genetic variations at the beta-1 receptor (ADRB1) are related to a higher risk of HF and cardiovascular events, particularly in individuals with long-term exposure to accumulated doses of beta-2 agonist.…”

Salmeterol attenuates the inflammatory response in asthma and decreases the pro-inflammatory cytokine secretion of dendritic cells

“…22 Salmeterol is used in combination with inhaled corticosteroids for long-term prevention and control of symptoms in moderate or severe, persistent asthma. 23 We investigated whether salmeterol could regulate the inflammation of asthma. Microscopically, the lung tissue of allergen-challenged mice showed peribronchial cell recruitment, together with hyperplasia of bronchial smooth muscle.…”