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Long-acting β2-agonist step-off in patients with controlled asthma
Jan L Brozek1, Monica Kraft, Jerry A Krishnan
1Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada.
Archives of Internal Medicine
|August 29, 2012
Summary
Discontinuing long-acting beta2-agonists (LABA) in asthma patients already controlled with combination inhalers increases asthma impairment. Evidence does not support LABA step-off when asthma is stable on inhaled corticosteroids and LABA therapy.
Area of Science:
- Pulmonology
- Pharmacology
- Clinical Medicine
Background:
- Concerns regarding long-acting beta2-agonist (LABA) safety in asthma management.
- US FDA recommends LABA withdrawal once asthma is controlled with combination inhaled corticosteroid (ICS) and LABA therapy.
Purpose of the Study:
- To systematically review and meta-analyze evidence supporting the discontinuation of LABA therapy in asthma patients with controlled asthma.
- Assess the impact of LABA step-off on asthma control and patient-reported outcomes.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (through August 2010).
- Included RCTs of LABA discontinuation in patients with asthma controlled by ICS/LABA combination therapy.
Main Results:
- Five RCTs involving patients aged 15+ met inclusion criteria.
- LABA step-off did not improve outcomes; it increased asthma impairment.
- Worsened quality of life (Asthma Quality of Life Questionnaire), asthma control (Asthma Control Questionnaire), reduced symptom-free days, and increased withdrawal risk.
Conclusions:
- Discontinuing LABA therapy in adults and older children with controlled asthma increases asthma-associated impairment.
- Further trials are needed to measure all long-term, patient-important outcomes after LABA discontinuation.
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