An article published in the Archives of Internal Medicine (July 15, 1997; vol. 127, no. 2:142–147) reviewed research conducted at Cornell University and Stanford University examining the safety of certain long-acting asthma inhalers.
The authors analyzed data from 19 clinical trials involving 33,826 patients. This meta-analysis focused on inhalers containing the long-acting beta-agonist drugs salmeterol or formoterol.
The analysis found that, compared with placebo:
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Patients using these inhalers were 3.5 times more likely to die
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Patients were 2.5 times more likely to be hospitalized
Based on these findings, the authors concluded that long-acting beta-agonist inhalers may have contributed to a substantial proportion of asthma-related deaths in the United States.
Symptom Relief vs. Disease Activity
Long-acting inhalers such as salmeterol and formoterol are effective at relieving asthma symptoms by relaxing airway smooth muscle. However, the research suggested that symptom relief does not necessarily correspond to improved airway health. Instead, these medications may increase airway sensitivity and inflammatory activity, potentially worsening the underlying disease process in some patients.
Asthma-related death remains relatively uncommon, with estimates of approximately 5,000 deaths per year in the United States. Nonetheless, this research raised concerns that certain inhalers, while providing temporary symptom control, may increase the risk of severe outcomes in a subset of patients.
Context
These findings contributed to later changes in asthma-management guidelines, including recommendations that long-acting beta-agonists be used cautiously and typically in combination with anti-inflammatory therapies rather than as stand-alone treatment.
