B2 agonists and their safety in the treatment of asthma

Increasing prevalence and severity of asthma has prompted the development and promulgation of various national and international guidelines for asthma management in adults and children. All of these guidelines agree that short-acting inhaled B2-agonists on demand represent the most appropriate initial bronchodilator therapy. However, there has been considerable debate as to the merit of maintenance bronchodilator therapy with regular inhaled B2-agonists, either the short acting agents, or the newer long-acting inhaled B2-agonist, salmeterol. Of concern is the possibility that there are detrimental effects of chronic B2-agonist bronchodilator treatment. Do these B2-agonists have the potential to worsen asthma control and thereby have an adverse impact by contributing to the increased prevalence and severity of asthma? This article will review the pertinent literature with regard to the safety of the B2-agonists, which are appropriate but not perfect medications for asthmatics. It will also put this information in perspective for the clinician and provide this author's recommendations for their use in managing the manifestations of chronic and recurrent asthma.