A 2004 meta-analysis of Long-Acting Beta Agonists (LABA) concluded that they were shown to increase severe and life-threatening asthma exacerbations as well as asthma-related deaths.1
Long-acting beta agonists; Salmeterol and Formoterol are sold in New Zealand as Serevent and Oxis or in combination with inhaled corticosteroids as Symbicort, Seretide and Vannair.
A previous meta-analysis of beta agonists concluded that regular beta agonist use for at least one week resulted in tolerance to their effects and poorer disease control compared to placebo. Regular use of beta agonist increased airway inflammation and increased asthma exacerbations. 2
The meta-analysis commented on the development of receptor desensitisation and down-regulation along with rebound bronchoconstriction after sudden withdrawal of beta agonists.1 It was concluded that “to date no randomised trials (of beta agonists in asthma) have demonstrated a reduction in disease progression or in mortality.”1
The same meta-analysis observed that if a study were funded or sponsored by a pharmaceutical company it was more likely to conclude that beta-agonists were helpful (73%) whereas only 10% of studies not declaring such support concluded that beta agonists were helpful. 1
Comment
Doctors at Gisborne hospital, Bruce Duncan and Patrick McHugh, have authored two Buteyko studies. 3 4 Based on the success of these and other studies they recommend non-pharmacological approaches to asthma management such as Buteyko need to be considered if we are to reduce the mortality and morbidity resulting from beta agonist use. 5 6 7 8 9
Buteyko Breathing Clinic practitioners' advice regarding medication use is consistent with the advice of the New Zealand Guidelines Group: to use beta agonists only when necessary with early use of inhaled (and/or oral) corticosteroids.
Follow these links to discussions on beta agonists and asthma on the NZMJ website:
Long-acting beta agonists—prescribe with care Journal of the New Zealand Medical Association, 07-July-2006, Vol 119
Julian Crane, Professor, Department of Medicine, Wellington School of Medicine and Health Sciences, Wellington
Beta agonists and asthma Journal of the New Zealand Medical Association, 13-October-2006, Vol 119 No 1243
Patrick McHugh, Clinical Director, Emergency Department, Gisborne Hospital, Gisborne
Bruce Duncan, Public Health Physician, Tairawhiti District Health, Gisborne
1 Salpeter SR, Ormiston TM, Salpeter EE. Meta-analysis: Respiratory tolerance to regular _2-
agonist use in patients with asthma. Ann Intern Med. 2004;140:802–13. http://www.annals.org/cgi/content/full/140/10/802
2 Spitzer WO et al., The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med. 1992 Feb 20;326(8):560-1
3 McHugh, P., Aitcheson, F., Duncan, B. and Houghton, F. Buteyko Breathing Technique for asthma: an effective intervention New Zealand Medical Journal 12 December 2003 Vol. 116 No 1187
4 McHugh, P., Aitcheson, F., Duncan, B. and Houghton, F. Buteyko breathing technique and asthma in children: a case series New Zealand Medical Journal 19 May 2006, Vol. 119 No 1234
5 Bowler, S.D., Green, A. and Mitchell, C.A. Buteyko breathing techniques in asthma: a blinded randomised controlled trial Medical Journal of Australia 1998; 169: 575-578
6 Opat A.J., Cohen M.M., Bailey M.J., Abramson M.J. A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video. J Asthma 2000; 37(7):557-64
7 Cooper, S., Osborne, J., Newton, S., Harrison, V., Thompson Coon, J., Lewis S. and Tattersfield, A. Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial Thorax 2003; 58:674-679
8 Slader, C.A., Reddel, H.K., Spencer, L.M., Belousova, E.G., Armour, C.L., Bosnic-Anticevich, S.Z., Thien, F.C.K., Jenkins, C.R. Double blind randomised controlled trial of two different breathing techniques in the management of asthma Thorax 2006;61:651-656
9 Cowie, R.L., Conley, D.P., Underwood, M.F., Reader P.G., A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma Respiratory Medicine May 2008 (Vol. 102, Issue 5, Pages 726-732)
