The clinical use of beta-receptor agonists: for and against

Although beta-receptor agonists are the most potent and fastest acting bronchodilators available at present, some studies have questioned their current use. Thus, the increase in asthma mortality in the U.K., New Zealand and Australia in the 1960s was linked to an increase in the use of inhaled beta-agonists and has been attributed variously to the toxicity of beta-agonists and especially isoprenaline or to the toxicity of propellant gases in aerosols. In addition, use of these products may cause the patient to delay seeking medical help. Due to the uncertainty concerning beta-agonist use in asthmatic patients, the recommended approach to management of the disease is to use the least possible medication consistent with achieving therapeutic control. Within this framework, drug therapy may be started at a low level and be increased gradually, or maximum treatment may be given at the start, with later reduction. In this context, beta-agonists play a major role and a therapeutic strategy with four steps in the management of asthma is presented, utilizing sodium cromoglycate, nedocromil sodium, inhaled corticosteroids, long-acting oral bronchodilators, anticholinergics, and oral corticosteroids for maintenance treatment and short-acting inhaled beta 2-agonists when needed.