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Author Bisgaard, H. url  openurl
  Title Long-acting beta(2)-agonists in management of childhood asthma: A critical review of the literature Type
  Year (down) 2000 Publication Pediatric Pulmonology Abbreviated Journal Pediatr Pulmonol  
  Volume 29 Issue 3 Pages 221-234  
  Keywords Administration, Topical; Adrenergic beta-Agonists/administration & dosage/*therapeutic use; Albuterol/administration & dosage/*analogs & derivatives/therapeutic use; Anti-Inflammatory Agents/therapeutic use; Asthma/*drug therapy; Asthma, Exercise-Induced/drug therapy; Bronchi/drug effects; Bronchial Hyperreactivity/drug therapy; Bronchodilator Agents/administration & dosage/*therapeutic use; Child; Double-Blind Method; Drug Combinations; Drug Tolerance; Ethanolamines/administration & dosage/*therapeutic use; Formoterol Fumarate; Glucocorticoids; Humans; Lung/drug effects; Randomized Controlled Trials as Topic; Salmeterol Xinafoate; Status Asthmaticus/drug therapy  
  Abstract This review assesses the evidence regarding the use of long-acting beta(2)-agonists in the management of pediatric asthma. Thirty double-blind, randomized, controlled trials on the effects of formoterol and salmeterol on lung function in asthmatic children were identified. Single doses of inhaled salmeterol or formoterol cause prolonged bronchodilatation (>12 h) and extended bronchoprotection against exercise-induced bronchoconstriction in children, some children achieving full protection for more than 12 h. Heterogeneity in bronchoprotection has been observed, and individual dose-titration may be attempted. The onset of action of formoterol is comparable to salbutamol, while salmeterol has a slower onset of action. Partial tolerance develops when long-acting beta(2)-agonists are used as regular treatment, including cross-tolerance to short-acting beta(2)-agonists. Regular treatment with salmeterol in children with or without corticosteroids provides statistically significant bronchodilatation, but the degree of improvement in lung function or bronchoprotection against exercise and nonspecific irritants is small with regular use. There is no evidence of anti-inflammatory effects from inhaled long-acting beta(2)-agonists, which is reflected by unchanged or increased bronchial hyperreactivity and no reduction of exacerbation rates. The evidence does not support a recommendation for long-acting beta(2)-agonists as monotherapy, nor does it support their general use as regular add-on therapy. In conclusion, long-acting beta(2)-agonists provide effective bronchodilatation and bronchoprotection when used as intermittent, single-dose treatment of asthma in children, but not when used as regular treatment. Future studies should examine the positioning of long-acting beta(2)-agonists as an “as needed” rescue medication instead of short-acting beta(2)-agonists for pediatric asthma management.  
  Address Department of Pediatrics, National University Hospital, Rigshospitalet, Copenhagen, Denmark.  
  Corporate Author Thesis  
  Impact Factor 02,704 First Author Bisgaard, H. Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Senior Author Bisgaard, H.  
  ISSN 1099-0496 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:10686044 Approved no  
  Call Number Serial 218  
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