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Formoterol effective for asthma exacerbations

By Jeremy Cockerill | March 15, 2010

Results from a systematic review and meta-analysis indicate that the long-acting beta-2 agonist (LABA) formoterol is as effective for the treatment of asthma exacerbations as short-acting beta-2 agonists (SABAs).

“The treatment of acute asthma includes the repetitive administration of SABAs, often in combination with inhaled anticholinergic agents, systemic corticosteroids, and supplemental oxygen,” say Gustavo Rodrigo (Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay) and colleagues.

However, they add that a number of studies have suggested that formoterol could be equivalent to salbutamol or terbutaline for the treatment of acute asthma.

“The rationale for using formoterol as a substitute to SABAs in the acute care setting relates to its duration of action and potential for reducing the need for repeated administration of bronchodilator therapy,” the researchers explain.

They therefore conducted a literature search for studies that compared formoterol with SABAs (salbutamol or terbutaline) for the treatment of asthma exacerbations in children and/or adults who presented to an emergency department or equivalent care-setting.

The primary outcomes were spirometric measures (FEV1 or peak expiratory flow) as absolute or predicted values, or change from baseline at various time points after administration of the study drugs.

In total, nine randomized controlled trials involving 576 patients were included in the final analysis.

The researchers found no significant differences in spirometric measures between formoterol- and SABA-treated patients at 30–40 minutes after the first administration, at the end of treatment, and at 60–90 minutes after the last dose.

There were also no significant differences between formoterol- and SABA-treated patients regarding the secondary endpoints of final serum potassium level, heart rate, QT interval, hospitalization rate, and total withdrawals.

Rodrigo and team conclude in the Annals of Allergy and Asthma Immunology: “The results of this systematic review support the efficacy and safety of formoterol as an alternative to SABA (salbutamol or terbutaline) as reliever therapy in mild to severe acute asthma exacerbations.”

They add: “Future trials are needed to assess the comparison of formoterol with SABAs in patients with acute life-threatening asthma and to examine the use of formoterol plus inhaled corticosteroids in acute asthma treatment.”