Asthma Related Death

• Long-acting beta 2-adrenergic agonists (LABAs), may increase the risk of asthma-related death.
• Data from a large placebo controlled US study that compared the safety of another long-acting beta2-adrenergic agonist (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma related deaths in patients receiving salmeterol. This finding with salmeterol is considered a class effect of the LABAs, including arformoterol or formoterol.
• Currently available data are inadequate to determine whether concurrent use of inhaled corticosteroids or other long term asthma control drugs mitigates the increased risk of asthma related death from LABA.
• Available data from controlled clinical trials suggest that LABA increase the risk of asthma-related hospitalization in pediatric and adolescent patients. Therefore, when treating patients with asthma, formeterol or arformeterol should only be used for patients not adequately controlled on a long-term asthma controlled emdication, such as an inhaled corticosteroid or whose disease severity clearly warrants initiation of treatment with both an inhaled corticosteroid and LABA.
• Once asthma control is achieved and maintained, assess the patient at regular intervals and step down therapy (e.g., discontinue the drug) if possible without loss of asthma control, and maintain the patient on a long term asthma control medication, such as an inhaled corticosteroid.
• Do not use these agents for patients whose asthma is adequately controlled on low or medium dose inhaled corticosteroids.