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Editorials |

Long-Acting Bronchodilators in COPD

Malcolm R. Sears, MB
Author and Funding Information

Hamilton, ON, Canada

Correspondence to: Malcolm R. Sears, MB, Professor of Medicine, Firestone Institute for Respiratory Health, St. Joseph's Healthcare, 50 Charlton Ave E, Hamilton, ON L8N 4A6, Canada; e-mail: searsm@mcmaster.ca



Chest. 2008;133(5):1057-1058. doi:10.1378/chest.07-2919
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The introduction of long-acting β-adrenergic bronchodilators into the management of asthma 18 years ago substantially impacted treatment algorithms. Addition of a long-acting β-agonist (LABA) in patients with asthma not controlled on low-to-moderate doses of inhaled corticosteroid (ICS) was more effective than doubling the dose of ICS.1 Combination LABA/ICS inhalers (salmeterol with fluticasone, or formoterol with budesonide) are widely used in management of chronic asthma. However, enthusiasm for long-acting bronchodilator use in asthma was sharply diminished by concerns about safety, particularly following reporting of the Salmeterol Multicenter Asthma Research Trial.2 The increase in mortality in the salmeterol arm of that study compared with placebo led to review of LABA therapy by the Pulmonary-Allergy Drugs Advisory Committee of the Food and Drug Administration (FDA), following which a “black box” warning was placed on both salmeterol and formoterol.3 The warning was also applied to combinations of these products with ICS, despite the adverse outcomes in the Salmeterol Multicenter Asthma Research Trial having occurred predominantly in patients not prescribed ICS at baseline.

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