Patients taking only salmeterol seen in the emergency department for asthma more likely to be hospitalized
Research Activities, January 2011, No. 365
Asthma episodes account for 1.8 million emergency department (ED) visits and nearly 500,000 hospitalizations each year. Patients with chronic asthma are typically treated with inhaled corticosteroids (ICS), so-called "controllers," to control lung inflammation. They use inhaled beta-agonists, adrenalin-like drugs, as "rescue" medications to open up the airways of the lungs during acute asthma episodes. Long-acting beta agonists (LABAs), such as salmeterol, are also used. However, they are not recommended as monotherapy in long-term management of asthma, because of a reported association with near-fatal or fatal events. In fact, a new study found that patients using only salmeterol who visited the ED for an acute asthma episode were much more likely to be hospitalized than other ED patients with asthma.
It also found that concurrent long-term therapy with ICS appears to protect these patients against this risk. A team of researchers led by Michael M. Liao, M.D., of the Denver Health Medical Center, studied 2,236 patients aged 12 to 54 with acute asthma in 115 EDs. They were divided into four groups based on the medications they were taking for asthma during the 4 weeks before their ED visit: no salmeterol or ICS, salmeterol monotherapy, ICS monotherapy, and combination ICS and salmeterol. After controlling for 20 factors affecting asthma outcomes, the group taking only salmeterol had more than twice the risk of hospitalization, whereas groups treated with ICS only or a combination of ICS and salmeterol had no greater risk of hospitalization than the reference group not taking salmeterol or ICS.
The findings from the ED setting reinforce the importance and safety of following guidelines for the long-term management of asthma advocated by the National Asthma Education and Prevention Program (NAEPP). The NAEPP guidelines state that LABAs should not be used as monotherapy and should only be added to concurrent ICS therapy in patients with moderate-to-severe asthma. This study was supported in part by the Agency for Healthcare Research and Quality (HS18123).
See "Salmeterol use and risk of hospitalization among emergency department patients with acute asthma," by Dr. Liao, Adit A. Ginde, M.D., M.P.H., Sunday Clark, M.P.H., Sc.D., and Carlos A. Camargo, Jr., M.D., Dr.P.H. in Annals of Allergy, Asthma, and Immunology 104, pp. 478-484, 2010.