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Are there any detrimental effects of the use of inhaled long-acting beta 2-agonists in the treatment of asthma?

treatment guidelines agree that they are the agents of choice to relieve bronchoconstriction in acute asthma.1'2 There has been considerable debate, however, as to the therapeutic value of regular inhaled shortacting 02-agonists long term.3'4 Particularly at issue is the concern that they may have the potential to worsen asthma control, thereby contributing to an increase in asthma mortality observed in certain countries. Salmeterol and formoterol are two long-acting inhaled 02-agonists that have been developed for use as maintenance treatment in asthma.5 To obtain maximum benefit from these long-acting drugs they have to be taken regularly to prevent symptoms rather than on an "as required basis" to treat symptoms; it is under these circumstances that the longer duration of action gives advantages over shorter-acting drugs. It is appropriate, therefore, to review available data to see whether the concern surrounding the use of short-acting 02-agonists should apply equally in the case of long-acting inhaled 032-agonists. It might be reasonable to expect that any potential adverse effects of regular :2-agonist use would be more obvious with more potent, selective, long-acting agents. The present article will review the effects of long-