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Editorials |

β2-Agonists: Déjà vu All Over Again : The Second-Generation Controversy

I. Leonard Bernstein, MD
Author and Funding Information

Affiliations: Cincinnati, OH
 ,  Dr. Bernstein is Clinical Professor of Medicine and Environmental Health Sciences, University of Cincinnati.

Correspondence to: I. Leonard Bernstein, MD, Clinical Professor of Medicine and Environmental Health Sciences, University of Cincinnati, 231 Bethesda Ave, M.L. 0563, Cincinnati, OH 45267-0563; e-mail: bernstil@email.uc.edu



Chest. 2002;122(3):763-765. doi:10.1378/chest.122.3.763
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Extract

Despite the significant contributions of inhaled synthetic sympathomimetic agonists to the therapeutic armamentarium of asthma, the benefit/risk ratio of these agents evoked controversy throughout the last half of the 20th century. Concern about possible serious adverse effects first emerged from the United Kingdom, Australia, and New Zealand in the mid-1960s, when a sudden increase in asthma mortality was attributed to overuse of a short-acting, dose-fortified formulation of isoproterenol.1 A recurrent rise in mortality occurring a decade later in New Zealand appeared to be associated specifically with regular use of inhaled fenoterol, a more selective, relatively short-acting β2-agonist (SABA).2 A Canadian retrospective case-control analysis3 of pressurized SABAs in patients with asthma suggested that increased asthma mortality was not necessarily due to fenoterol alone but also occurred after overuse of any pressurized SABA of the same class. A subsequent meta-analysis4 of six similar surveys not only failed to confirm this conclusion but found that mortality was increased to a slight extent only in patients who used nebulized SABAs on a regular basis. Although this first generation controversy vis-à-vis SABAs and mortality still engenders debate, the current consensus about mortality attributed to SABAs is most likely based on overdosage and/or abuse by poorly controlled patients.

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    Print ISSN: 0012-3692
    Online ISSN: 1931-3543