Safety of Long-acting Bronchodilators

The underlying cause of asthma is airway inflammation.

Inflammation is frequently caused by external things, such as pollens, dust, cold air or germs. It comes as somewhat of a surprise then that many asthmatics are prescribed the twice-daily use of powerful long-acting beta-agonist bronchodilators that do little to address airway inflammation, but instead relax smooth muscles, allowing these external things to enter deeper into the lungs.

One main concern with this practise of taking long-acting bronchodilators is that the asthmatic is less aware of underlying airway inflammation severity because the drugs mask symptoms.(1) One British study reveals that the risk of dying as result of asthma is three times higher in asthmatics using long-acting Serevent than short-acting Ventolin(2). These deaths are likely to be due to airway obstruction (3,4), the very thing that these drugs are designed to overcome.

Few doctors would tell a patient with a sprained ankle to take a pain killer every day in order to continue walking normally because this would mask the problem, worsen the inflammation, and cause more damage to the ankle. Since the underlying cause of asthma is believed to be inflammation in the airways, and long-acting bronchodilators tend to cover up symptoms, it seems possible that they could contribute to increased inflammation and airway remodelling, making asthma worse in the long term.

(1) McIvor RA,Pizzichini E, Turner MO, Hussack P, Hargreave FE, Sears MR. Potential masking effect of salmeterol on airway inflammation in asthma. Am J of Respir Crit Care Med. 1998;158(3):924 - 930
(2) Busse WWD. Long and Short-acting Beta2-Adrenergic Agonists. Arch Internal Med. 1996;156:1514 - 1520
(3) Molfino NA, Nannini LJ, Martelli AN, Slutsky AS. Respiratory Arrest in near-fatal asthma. N Engl J Med. 1992;324:285 - 288
(4) Lipworth BJ. Risks versus benefits of beta2-agonists in the management of asthma. Drug Safety. 1992;7:54 - 70

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