Long-acting beta-agonists in adult asthma: Evidence that these drugs are safe

If asthma is not controlled with low-dose inhaled corticosteroids (ICS), by far the best next step is the addition of a long-acting, inhaled beta-agonist (LABA). Questions regarding the safety of this class of drug have been raised. However, careful examination of the reports which have caused concern in this regard does not reveal any evidence of an increased risk associated with the appropriate use (i.e. in combination with an inhaled ICS) of LABAs in asthma. There is much to suggest that the adverse outcomes associated with LABA monotherapy have been due to "masking of inflammation" rather than a toxic effect of the drugs. In some instances, this has likely allowed worsening asthma to be overlooked - with dire consequences. Studies in subjects receiving combination therapy with LABAs plus ICSs suggest that, if anything, there is an enhanced anti-inflammatory action with the LABA/ICS combination superior to that achieved with ICS alone at the same dose.