Long-acting beta2 agonists for childhood asthma

Abstract

Long-acting beta2 agonists are currently overprescribed in children. They are also often used inappropriately as first-line therapy and are not recommended for children aged five years or less. Due to the paucity of paediatric clinical trials, the evidence for the efficacy and safety of long-acting beta2 agonists in children is limited. There is little evidence that they reduce the risk of severe exacerbations and some evidence that they may actually increase the risk. The regular use of long-acting beta2 agonists may also result in a loss of protection against exercise-induced bronchoconstriction, and the development of tolerance to short-acting beta2 agonists. Long-acting beta2 agonists are only one option for children whose asthma is not adequately controlled with inhaled corticosteroids alone - the other options being an increase of inhaled corticosteroid dose or the addition of a leukotriene receptor antagonist. For children whose major ongoing symptoms are activity related, the addition of a leukotriene receptor antagonist is the preferred option.