Long-acting β₂-agonists in the management of asthma exacerbations

Purpose of review: Asthma exacerbations are a major cause of mortality in the United States. Although long-acting β₂-agonists have a defined role in maintenance therapy, their potential use in exacerbations remains largely undetermined. This paper reviews recent literature on long-acting β₂-agonists in the context of the management of acute asthma. Recent findings: Although clinical experience with long-acting β₂-agonists now approaches 20 years, their applicability in asthma exacerbations has only recently been explored. Formoterol, with a rapid onset of action similar to albuterol, has already been approved in Europe as a reliever medication and there are emerging data to support its use in the outpatient management of mild exacerbations of asthma. Salmeterol added to conventional therapy has been found to be safe and potentially beneficial in patients hospitalized for an exacerbation. Summary: Long-acting β₂-agonists have proved to be useful in the chronic management of asthma and the prevention of exacerbations. Recent data suggest a role for patient-guided management using adjustable dosing of long-acting β₂-agonists with inhaled corticosteroids during periods of worsening asthma. Further research to evaluate the potential role of long-acting β₂-agonists in the management of acute asthma is needed.